California 

gional 

cility 


LIBRARY 

California' 

IViNF 


Sanitation  in  California.  155 

carefully  guarded  against  debasing  influences.  The  public  look 
to  the  medicaP^orofession  for  the  conservation  of  their  health 
interests,  and  it  is^especially  our  fault  if  they  go  wrong  or  fall 
short  of  due  measure 

I  desire  to  state  here^fchat  one  of  my  colleagues  on  this  com- 
mittee, as  well  as  in  the  S^ate  Board  of  Health,  suggests  the 
utility  of  sanitary  conventionsVto  be  held  under  the  auspices  of 
the  State  Board  of  Health.  The\object  is  to  arouse,  in  various 
parts  of  the  State,  an  interest  in\public  hygiene  among  all 
classes  of  people. 

Such  conventions  have  been  held  inN^ichigan,  Ohio,  Penn- 
sylvania, Kansas  and  other  States,  and  "the  proceedings,  em- 
bodied in  the  reports  of  their  State  Boards  6»£  Health,  indicate 
good  work  in  the  character  of  the  papers  read  and  the  discus- 
sions upon  them,  and  in  the  attendance  upon  the  meetings.  In 
my  judgment  this  proposition  is  worth  trial,  and  "I  hope  and 
believe  that  useful  results  would  follow. 


_LEPROSY_ 

ITS  EXTENT  AND  CONTROL,  ORIGIN  AND  GEOGRAPHICAL 
DISTRIBUTION. 


By  H.  S.  ORME,  M.  D.,  Los  Angeles. 

The  origin  of  leprosy,  like  the  source  of  other  specific  mala- 
dies, is  totally  unknown.  In  its  present  form  it  has  certainly 
prevailed  for  thousands  of  years — long  anterior  to  the  dawn  of 
authentic  history.  The  earliest  description  of  the  disease  was 
written  by  the  Hindoo  Atreya,  who  is  supposed  to  have  lived 
2000  years  B.  G.,  but  it  is  so  vague  and  the  symptoms  so  varia- 
ble that  he  may  have  included  several  different  affections  under 
the  common  term  Kushta,  as  he  attributed  most  of  the  morbid 
appearance  to  wind.  Whatever  this  may  mean,  it  is  evident  that 
both  causes  and  symptoms  were  then  very  imperfectly  under- 
stood. The  same  vagueness  is  found  in  the  description  of  (sar- 
aath  by  Moses  in  Leviticus,  and  the  fact  that  both  considered 
certain  forms  curable  indicates  that  several  distinct  pathological 
conditions  were  included  under  one  term.  Moses  probably 
made  no  distinction  between  true  leprosy  and  certain  macular 
and  scaly  eruptions,  since  the  weekly  inspection  of  suspected 
casea  would  have  no  significance  in  leprosy,  and  the  ceremonial 
observances  of  cleansing  would  be  useless  in  this  affection.  All 
this  is  not  strange  when  we  consider  that  medical  writers,  until 
nearly  the  middle  of  the  present  century,  made  no  clear  distinc- 
tion between  typhus  and  typhoid  fevers;  and  that,  until  the 
middle  of  the  18th  century,  both  measles  and  scarlatina  were 
included  under  the  common  term  morbilli;  while  the  Arabian 
physicians  some  centuries  earlier  classed  small-pox  in  the  same 
category  with  the  other  two.  We  shall  see  later  on  that  some 
individuals  of  our  day  regard  leprosy  and  syphilis  as  variations 
of  the  same  disease. 

It  is  probable  that  leprosy,  as  we  now  understand  it,  has  not 
been  absent  from  the  most  ancient  seats  of  civilization,  China, 
India  and  Egypt,  since  some  undefinable  period  in  the  childhood 
of  our  race.  Whether  in  these  countries  it  was  more  or  less 


Leprosy.  157 

prevalent  in  remote  ages  than  now,  can  only  be  conjectured; 
but  its  history  in  Europe  during  the  Christian  era  is  so  well 
known  that  we  are  certain  of  its  general  ravages  from  the  12th 
to  the  15th  centuries,  when  it  is  estimated  that  there  were  as 
many  as  1900  lazarettos  devoted  to  the  treatment  of  lepers  at  one 
time  in  the  various  countries  of  Europe.  These  establishments 
were  instituted  in  France  in  the  8th  century;  in  Ireland  about 
the  middle  of  the  8th;  in  Spain,  at  the  beginning  of  the  llth; 
in  England,  during  the  llth;  in  Scotland,  and  the  Netherlands, 
during  the  12th;  and  in  the  following  century  in  Norway  (1266). 
There  is  evidence  of  civil  regulations  touching  lepers  in  Lom- 
bardy  as  early  as  the  year  643,  and  in  France  in  757.  The 
Church  Council  at  Orleans  in  549  imposed  the  care  of  lepers  on 
the  Gallic  bishops,  and  this  was  confirmed  by  one  held  at  Lyons 
in  583.  Dr.  Erasmus  Wilson  avers  that  it  had  reached  En- 
gland in  the  6th  century.  It  seems  strange  that  leper  hospitals 
should  not  have  been  established  there  for  four  centuries. 

Since  the  beginning  of  the  16th  century  it  has  declined,  and 
at  the  present  time  has  mostly  disappeared  in  that  part  of  the 
world.  Its  introduction  to  Europe  has  been  variously  attribu- 
ted to  the  arrival  of  the  Roman  legions  from  Eastern  conquests 
and  the  return  of  the  Crusaders  in  the  llth  and  12th  centuries. 
It  is  more  than  probable  that  leprosy  had  gained  a  foothold 
before  the  Christian  era,  that  the  returning  Crusaders  intro- 
duced it  afresh  and  spread  it  over  the  land.  The  world's  medi- 
cal history  during  the  intervening  ages  is  exceedingly  scanty 
and  vague. 

At  the  present  time  it  lingers  in  some  parts  of  Europe  far 
separated  from  each  other  and  nowhere  in  threatening  propor- 
tions. In  Spain,  in  the  lazaretto,  at  Granada,  there  were  53 
cases  in  1860.  Within  the  present  decade  there  has  been  a 
much  smaller  number  in  a  lazaretto  at  Barcelona.  There  are 
no  legal  restrictions  on  lepers  in  Spain,  but  it  is  probable  that 
social  ostracism  here,  as  in  most  parts  of  the  world,  drives 
them  as  outcasts  into  seclusion,  and  it  is  also  probable  that 
many  small  groups  of  lepers  remain  undiscovered  or  unmen- 
tioned  in  various  obscure  communities.* 


*Sir  Morell  ]Y1  ackenzie,  in  a  recent  article  on  "The  Dreadful  Revival  of 
Leprosy,"  sounds  a  loud  warning  note,  and  declares  that  unless  prompt 
measures  are  taken,  we  have  every  prospect  of  seeing  a  great  spread  of  this 
full  disease  through  the  countries  which  are  to-day  comparatively  free.  The 
contagiousness  of  leprosy  he  considers  beyond  question. — Ind.  Med.  Jour 


158  Leprosy. 

The  history  of  leprosy  in  the  Sandwich  Islands  is  of  surpass- 
ing interest,  owing  to  its  dreadful  ravages  and  the  recent  date 
of  its  recognized  appearance.  Its  introduction  has  generally 
been  charged  to  Chinese  immigrants  or  coolies,  and  this  notion 
is  connected  with  the  vernacular  term,  "mai  pake,"  Chinese 
sickness. 

The  common  agreement  is  that  leprosy  bad  not  made  much 
headway  previous  to  1860.  Dr.  Hillebrand  avers  that  it  was 
brought  by  the  Chinese  in  1848.  Dr.  Saxe  states:  "Leprosy 
was  unknown  to  the  natives  until  1848,  when  it  was  introduced 
by  the  Chinese,  and  Ahai,  a  Chinaman  was  the  first  leper 
recognized  by  the  Hawaiian  Board  of  Health." 

Dr.  Emerson,  President  of  the  Board  of  Health  of  the 
Hawaiian  Kingdom,  says  in  his  report  for  1888:  "Leprosy  was 
first  clearly  made  out  to  exist  in  this  country  about  the  year 
1840  in  the  person  of  one  Naea,  a  messenger  of  the  chiefs,  who 
died  in  1852.  The  friends  of  Naea  thought  he  had  the  disease 
for  about  ten  years  before  his  death.  His  case  was  reported  by 
the  Rev.  D.  D.  Baldwin,  M.  D.,  of  Lahaina,  in  a  communica- 
tion to  the  Minister  of  the  Interior,  Hon.  Chas.  G.  Hopkins, 
dated  May  26th,  1864.  In  1863,  Dr.  Baldwin  obtained  by 
reports  from  the  deacons  of  his  Church  at  Lahaina,  the  names 
of  sixty  people  who  were  supposed  to  be  affected  with  the  dis- 
ease." 

Since  the  discovery  of  the  Sandwich  Islands  in  1778,  they 
have  often  been  visited  by  ships  manned  by  sailors  from  regions 
of  the  world  where  leprosy  constantly  prevails,  and  leprous 
sailors  might  have  planted  the  disease  by  cohabitation  with  the 
native  women.  Besides,  large  numbers  of  Hawaiian  seamen 
have  sailed  to  all  the  shores  of  the  Pacific  and  Indian  Oceans, 
and  they  could  easily  have  contracted  it  by  intercourse  with 
lepers  abroad,  and  afterwards  have  communicated  it  to  their 
countrymen  at  home. 

One  indication  that  leprosy  is  not  an  ancient  occupant  of 
these  islands,  is  the  fact  that  the  majority  of  the  cases  are  of 
the  tubercular  form,  and  formerly  the  preponderance  was  still 
more  marked;  while  in  India  and  China,  where  it  has  existed 
many  centuries,  the  anaesthetic  type  is  the  prevailing  one. 

In  1886,  of  652  cases  at  the  Molokai  settlement,  333  were 
classed  as  tubercular,  204  as  anaesthetic  and  115  as  mixed.  Leper 
population  March  31,  1888,  at  Molokai,  males  495,  females  254, 
total  749. 


Leprosy.  159 

By  1864,  leprosy  had  increased  among  the  natives  to  such  an  t 
extent  that  the  authorities  and  people  of  intelligence  became 
alarmed,  and  in  1865  a  law  was  enacted  providing  for  the  isola- 
tion of  all  lepers.  There  has  always  been  great  difficulty  in  its 
execution,'  not  from  open  resistance,  but  from  the  hiding  and 
secretion  of  lepers.  Several  characteristics,  on  the  amiable  side 
of  human  nature,  obtain  to  excess  among  these  simple  people, 
which  promotes  in  the  highest  degree  the  spread  of  contagious 
diseases, 

Christianity  and  civilization  have  failed  to  eradicate  the  indis- 
criminate sexual  relations  which  have  always  existed,  and  inter- 
course with  foreign  ships'  crews  since  1779,  the  date  of  Capt. 
Cook's  arrival,  has  saturated  the  population  with  venereal 
diseases,  so  that  a  great  many  of  the  people  of  both  sexes  are 
believed  to  be  subjects  of  syphilis,  either  inherited  or  acquired. 
Again,  these  people  are  the  most  friendly  and  sociable  creatures 
in  the  world,  both  with  strangers  and  each  other.  Persons 
suffering  with  the  most  loathsome  diseases  are  not  to  them 
objects  of  abhorrence,  but  rather  of  benevolent  attention.  In 
their  homes  and  in  their  social  relations  they  observe  the  closest 
habits  of  affectionate  intercourse,  eating  from  the  fingers  from  a 
common  dish,  passing  the  pipe  from  one  mouth  to  another,  and 
sleeping  together  indiscriminately  in  their  small,  close  habita- 
tions. The  race  distribution  of  leprosy  in  these  islands  is  strik- 
ing. Nearly  90  per  cent  of  the  known  cases  have  been  among 
the  native  race.  Though  the  Chinese  are  accused  of  introducing 
the  disease,  they  have  contributed  very  few  to  the  leper  popula- 
tion; and  the  President  of  the  Board  of  Health  in  1886  asserted 
that  he  had  not  known  of  an  imported  Chinese  leper  since  the 
enactment  of  the  anti-leprosy  law. 

The  unexampled  spread  of  leprosy  in  these  islands  after  1870 
may  be  attributed  to  several  causes.  There  can  be  no  doubt 
that  the  lowering  of  the  vital  stamina  of  the  race  by  the  great 
prevalence  of  syphilis,  prepared  them  for  the  inroads  of  any 
disease  that  might  threaten.  During  this  period  small-pox  also 
scourged  the  people,  and  in  1868  there  began  a  general  vaccina- 
tion in  which  virus  was  taken  indiscriminately  from  human  sub- 
jects. This  reckless  practice  doubtless  contributed  greatly  to 
the  spread  of  both  syphilis  and  leprosy. 


160 


Leprosy. 


TABLE   OP    LEPERS    AT   THE    MOLOKAI    SETTLEMENT,    HAWAIIAN   ISLANDS 

1866—1886. 


YEAR. 

LEPERS  REC'D. 

PRESENT 
JAN.  1. 

Q 

9 

3 

DISCHARGED. 

3  . 

a  SS 

3~ 

•< 

NATIONALITIES. 

M. 

103 
57 
76 
73 
31 
128 
69 
295 
53 
128 
57 
110 
136 
82 
34 
156 
53 
185 
71 
75 
16 

F. 

TOTAL. 

HA- 
WAI. 

WHITE 

CHI- 
NESE. 

OTH- 
ERS. 

1866.. 

1867  .... 
1868.... 
1869.... 
1870.... 
1871.... 
1872.... 
1873.... 
1874.... 
1875.... 
1876.... 
1877.... 
1878.... 
1879.... 
1880.... 
1881  .... 
1882.... 
1883.... 
1884.... 
1885.... 
1886. 

38 
13 
39 
53 
26 
55 
36 
192 
38 
84 
39 
53 
103 
43 
17 
76 
18 
116 
37 
28 
7 

141 

70 

115 
126 
57 
183 
105 
487 
91 
212 
96 
163 
239 
125 
51 
232 
71 
301 
108 
103 
23 

26 
25 
28 
59 
58 
51 
64 
156 
161 
163 
122 
129 
147 
209 
152 
132 
121 
150 
168 
142 
20 

10 

7 
2 
11 
4 
9 
4 
21 
8 
14 
3 
1 
.... 

10 

is 

10 
7 
25 

139 
68 

113 
126 
57 
183 
105 
483 
90 
207 
95 
162 
238 
123 
50 
229 
68 
300 
99 
99 

2 

105 

143 

228 
284 
279 
402 
439 
749 
671 
706 
677 
710 
802 
717 
606 
706 
643 
784 
717 
653 

1 
1 

1 

1 

6 
5 
8 
14 
8 
16 
5 
13 
27 
37 
41 
51 
60 
149 
93 
96 
23 

3 

1 

1 

3 
1 

1 

1 

1 

1 

1 
1 
2 
1 

1 

1 

2 
1 
6 
3 



2 
1 

1 

Of  the  above  there  were : 

Full  blooded  Hawaiians 2,997 

Mixed  Hawaiians 37 

Chinese 22 

Whites 16 

Other  Nationalities 4 

Male  Hawaiians 1,903 

Female  Hawaiiaus 1,094 

Dr.    N.    B.    Emerson,    President    of   the   Board   of  Health, 

reported  the  inmates  at  the  Molokai  settlement  present  January 
15,  1889,  as  follows: 

Males  over  10  years  of  age 651 

Males  under  10  years  of  age 15 

Females  over  10  years  of  age 360 

Females  under  10  years  of  age   10 


Total 1,036 

Of  the  above  there  are  eight  Chinese  and  eight  or  ten  whites 
(American,  English,  German,  French,  etc.).  The  number  of 
lepers  still  at  large  is  small  and  rapidly  diminishing.  March  31, 
1888,  they  were  estimated  to  be  altogether  644. 


Leprosy.  161 

There  is  no  apparent  reason  J,o  suppose  that  leprosy  existed 
in  any  part  of  the  New  World  prior  to  its  discovery  by  Colum- 
bus. At  that  date  it  prevailed  throughout  Europe,  and  followed 
the  tide  of  immigration.  Whether  it  was  introduced  independ- 
ently from  Africa  is  conjectural,  but  it  has  certainly  been  found 
more  among  people  of  the  African  race  than  among  all  others 
in  America.  Their  habits  of  life  have  always  favored  the  pro- 
pagation of  spreading  diseases,  and  leprosy  has  ever  found  its 
victims  chiefly  among  people  and^individuals  who  live  in  closest 
social  relations.  With  the  advance  of  civilization,  the  enlarge- 
ment of  habitations,  abundance  of  clean  garments  and  beds, 
and  the  use  of  separate  table  utensils,  the  disease  has  declined 
and  nearly  disappeared  from  the  civilized  world. 

In  British  Guiana  leprosy  is  supposed  to  have  come  with 
African  slaves.  Negro  lepers  were  isolated,  and  the  disease  was 
confined  to  them.  In  1831,  they  numbered  431,  and  were  then 
sent  to  a  special  establishment  on  the  river  Pomeroon.  Near 
by  were  several  Indian  tribes,  all  of  which  withdrew  except  the 
Warrows,  who  associated  with  the  lepers.  In  1842,  a  census 
was  taken  of  the  Indians,  and  many  lepers  were  found,  but  all 
were  Warrows.  In  1838  came  emancipation,  followed  by  the 
dispersion  of  the  negroes  and  the  introduction  of  coolies  from 
India  and  China,  some  of  whom  were  probably  lepers.  Now  2 
in  1,000  of  the  population  are  lepers,  including  whites,  negroes, 
Indians,  coolies  and  the  mixed  races.  (Pacif.  M.  and  S.  Jour., 
Jan.,  1887.)  There  is  good  reason  to  believe  that  leprosy  ap- 
peared in  the  West  India  Islands  not  long  after  their  settlement 
by  Europeans.  Dr.  Hans  Sloan,  who  was  in  Jamaica  in  1687, 
mentions  a  case  and  describes  native  plants  used  in  the  treat- 
ment of  the  disease.  (Prof.  Jones  in  N.  0.  Med.  &  Surq.  Jour., 
March,  1878.) 

In  Jamaica  at  present  there  are  said  to  be  700  or  800  lepers, 
negroes  and  mulattoes.  In  Barbadoes  it  is  thought  that  the 
increase  of  lepers  is  four  times  as  rapid  as  that  of  the  population. 
On  the  Island  of  Trinidad,  according  to  Dr.  W.  H.  Park,  there 
were  three  lepers  in  1805;  and  in  1878  about  860.  In  the  Brit- 
ish West  Indies,  as  in  most  of  the  other  British  Colonies,  there 
is  no  isolation  of  lepers. 

It  is  quite  probable  that  leprosy  exists  on  most,  if  not  all, 
the  other  West  India  Islands ,  but  its  extent  is  unknown. 

In  the  American  Colonies    of    the   Netherlands  lepers  are 


162  Leprosy. 

strictly  segregated  in  Government  asylums.  The  one  in  Suri- 
nam has  102  inmates,  of  whom,  in  1883,  37  were  Europeans,  56 
natives  and  9  immigrants  from  British  India.  In  1884,  the  asy- 
lum in  Curacon  contained  13  inmates;  that  in  St.  Martin  10; 
and  that  in  St.  Eustatius  19.  Their  isolation  results  from  gen- 
eral belief  in  these  colonies  of  the  contagiousness  of  leprosy, 
which  belief  is  not  entertained  in  East  Indian  Colonies. 

I  have  no  precise  information  upon  leprosy  in  other  South 
American  States,  except  a  denial  of  its  existence  in  Chili  to  the 
inquiry  of  the  Hawaiian  Government.  It  is  said  to  exist  in  Bra- 
zil, and  probably  is  absent  from  few,  if  any,  of  those  countries. 

Dr.  Miguel  Valladores,  Physician  to  the  lazaretto  of  Guate- 
mala, reports  to  the  Hawaiian  Government  that  leprosy  is 
almost  unknown  among  the  aboriginal  Indians  of  pure  race. 
His  patients  have  all  been  of  mixed  Spanish  and  Indian  blood. 
He  states  that  lepers  are  strictly  segregated,  and  that  he  had 
under  his  care  9  men  and  6  women.  Isolation  has  only  lately 
been  put  in  force.  Previously  leprosy  was  on  the  increase. 
The  Hawaiian  Consul  remarks:  "Well-to-do  families  contrive 
to  secrete  an  afflicted  member  of  the  family  in  some  remote 
place;  this  is  to  my  personal  knowledge."  I  have  no  doubt 
that  the  practice  of  secreting  lepers  is  general  throughout  the 
world,  wherever  the  disease  prevails,  and  it  is  not  difficult  in  an 
early  stage,  for  lepers  to  evade  the  authorities  and  go  about 
their  usual  business.  I  have  no  particulars  from  other  Central 
American  States,  but  am  disposed  to  believe  that  occasional 
cases  of  this  disease  might  readily  be  found  among  the  lowest 
class  of  people. 

Dr.  Gomez,  Director  of  the  Lazar  Department,  Juarez  Hos- 
pital, Mexico,  reports  that  leprosy,  called  "  Mai  de  San  Lazaro," 
exists  principally  in  the  western  regions  of  the  Republic.  Dur- 
ing his  13  years'  service  he  has  had  no  negroes  under  his  charge, 
but  observes  no  other  race  preferences. 

The  disease  has  been  known  in  Mexico  since  the  conquest, 
and  Cortez  founded  a  lazaret.  At  the  present  time  lepers  in  the 
city  of  Mexico  are  admitted  to  separate  wards  in  a  civil  hospi- 
tal for  each  sex.  The  average  number  of  patients  is  30.  The  Su- 
perior Council  of  Health  reported  in  1886,  that  leprosy  in  Mexi- 
co existed  prior  to  the  conquest.  There  have  been  no  special 
leper  hospitals  for  more  than  20  years,  but  the  lepers  are  received 
in  civil  hospitals  throughout  the  country.  In  early  times  seg- 


Leprosy. 


163 


regation  in  special  hospitals  was  practiced.  It  is  the  belief  of 
the  Council  that  leprosy  has  decreased  in  Mexico  in  the  last  75 
years,  but  the  fact  is  not  accounted  for.  As  to  its  ancient 
prevalence  may  not  early  observance  have  confounded  true 
leprosy  with  elephantiasis  Arabum,  or  Barbadoes  leg? 

Sporadic  cases  of  leprosy  have  been  recognized  in  British 
Columbia  within  a  few  years.  The  most  notable  focus  of  the 
malady  at  present  on  this  continent  is  at  Tracadie,  N.  B.,  in  that 
portion  bordering  on  the  Bay  of  Chaleurs  and  river  of  St.  Law- 
rence. Its  origin  is  not  precisely  known.  Dr.  W.  H.  Park 
states  that  it  began  with  a  woman  named  Ursale  Landry  in  1819. 
Prof.  J.  C.  White  (Am.  J.  Med.  Sci.,  Oct.,  1882)  refers  its  source 
in  1815,  to  a  woman  named  Benoit,  whose  mother  came  from 
Normandy.  As  no  preventive  measures  were  used,  it  gradually 
spread  among  different  families,  but  mostly  among  the  descend- 
ants of  the  first  case.  The  first  leper  hospital  was  established 
in  1844,  and  32  cases  were  received  within  five  years.  The  hos- 
pital at  Tracadie  was  founded  in  1849,  and  between  this  date 
and  1882  more  than  100  patients  were  received.  None  are 
admitted  during  the  first  year  of  the  affliction,  and  very  few 
defore  the  third  year.  Belief  in  its  contagiousness  is  general 
among  the  people,  and  plainly  recognized  lepers  are  impelled 
by  social  ostracism  to  go  into  retirement.  Nearly  all  the  cases 
have  been  of  French  descent.  So  far  no  Indian  has  fallen  a 
victim. 

The  following  table  exhibits  the  vital  movement  for  the  period 
1875-85: 

TABLE    OF    LEPERS    IN    THE    PROVINCE    OF    NEW    BRUNSWICK. 

1875-1885. 


YEAE. 

IN  LAZAKET. 
M.      F. 

OUTSIDE. 
M.    F. 

TOTAL. 
M.   F. 

NKW  CASES. 
M.      F. 

DIED. 
M.    F. 

TOTAL. 

1875  

13 

10 
6 
9 
8 
6 
8 
11 
10 
10 
11 

7 
5 
8 
8 
7 
9 
13 
14 
12 
11 
10 

6 

7 
7 
5 
4 
5 
5 
4 
4 

3 
2 

10 
12 
9 
7 
8 
8 
3 
1 
1 
1 
1 

20 
17 

13 
14 
12 
11 
13 
15 
14 
13 
13 

16 
17 
17 
15 
15 
17 
16 
15 
13 
12 
11 

1 
1 

2 
2 

1 
1 
2 
2 

1 
2 
1 
2 
2 
2 

2 

3 
6 

1 
3 
2 

2 
1 
3 
2 

i 

1 
2 
1 
1 

36 
34 
30 
29 

27 
28 
29 
30 
27 
25 
24 

1876  
1877  

1878  

1879  

1880  

1881  
1882  

1883  

1 
1 

1884  

1885  

Dr.  A.  C.  Smith,  physician  in  charge  in  December,  1889,  re- 
ported 20  inmates,  9  males  and  11  females.     Two  were  admitted 


164  Leprosy. 

during  the  year,  in  which  time  there  were  no  deaths.  In  Sep- 
tember, 1889,  he  reported  about  18  lepers  in  Tracadie.  It  thus 
appears  that  the  disease  has  steadily  diminished  since  the  plan 
of  isolation  was  established,  the  apparent  increase  being  ac- 
countable by  discovery  of  cases  previously  concealed  or  not 
recognized.  As  will  be  seen  hereafter,  there  have  been  some 
desertions . 

Prof.  White  gives  a  group  of  11  cases  of  leprosy,  which  were 
traced  out  in  the  Island  of  Cape  Breton,  six  of  whom  consisted 
of  a  woman  and  her  five  children.  There  was  also  a  son-in-law 
and  two  children,  and  another  son-in-1  aw  whose  wife  was  not  a 
leper,  but  he  used  to  sleep  with  one  of  his  leper  brothers-in- 
law.  The  other  case  waited  on  one  of  the  sons  and  washed  and 
laid  him  out  after  death. 

The  first  case  became  affected  in  1852  and  the  last  in  1870. 
All  were  dead  before  1882,  except  the  last,  and  he  was  far  ad- 
vanced. It  is  worthy  of  notice  that  the  mother  of  these  chil- 
dren and  first  of  the  group  was  born  on  Prince  Edward's  Island 
in  1836,  which  island  is  not  far  from  the  New  Brunswick  seat  of 
leprosy. 

Somewhat  more  than  25  years  ago  the  discovery  was  made  of 
the  existence  of  leprosy  among  immigrants  from  Norway  in  sev- 
eral of  the  new  Northwestern  States  of  the  Union.  From  that 
time  to  the  present  scattering  cases  have  occurred,  but  the  dis- 
ease shows  no  tendency  to  spread.  It  is  easy  to  trace  direct 
connection  between  them  and  the  leprous  population  of  West- 
ern Norway. 

In  1863  Dr.  Holmboe,  of  Norway,  visited  his  countrymen  in 
those  States  and  found  12  lepers  among  them,  most  of  them 
diseased  before  emigrating.  In  no  case  had  a  native  child  of 
this  country  veloped  the  disease,  and  it  was  observed  to  pur- 
sue a  milder  and  more  prolonged  course  in  this  country  than  in 
Norway.  (Prof.  J.  C.  White  in  Am.  J.  M.  Sci.,  Oct.,  1882.)  It 
has  been  asserted  that  Norwegian  lepers  have  been  advised  at 
home  to  emigrate  to  this  country,  for  the  benefit  of  their  health. 

In  1869-70  Prof.  Wm.  Boeck,  Christiana,  visited  the  N.  W. 
States,  and  found  18  cases  in  Wisconsin,  Iowa  and  Minnesota, 
all  from  Western  Norway.  Of  these  9  were  of  the  anaesthetic 
type,  3  tubercular,  and  6  mixed.  Four  of  them  knew  of  no 
leprous  relatives.  (Report  Minn.  Board  of  Health,  1884-)  Up 
to  1879  26  cases  had  been  reported  in  Wisconsin,  Iowa,  Min- 
nesota and  Nebraska  among  Norwegian  and  Swedish  immigrants. 


Leprosy.  165 

A  child  of  a  leprous  father  born  in  this  country,  was  reported  by 
Dr.  Hyde  in  1879,  the  only  native  leper  of  this  group.  (Dr.  J. 
L.  Babcock,  N.  Y.  Med.  Pec.,  Sept.  15,  1888.)  In  1886,  Dr.  K. 
Hoegk.  member  of  the  Wisconsin  State  Board  of  Health,  as  the 
result  of  his  investigation,  stated  his  opinion  that  at  least  160 
Norwegian  lepers  (probably  more)  had  come  to  this  country 
since  1858.  Norwegian  records  contain  the  names  of  68.  Many 
developed  the  disease  after  arrival,  and  some  doubtless  escaped 
notice.  In  1886  he  knew  of  three  cases  in  that  State. 

The  State  Board  of  Health  of  Minnesota  in  Oct.,  1889,  re- 
ported to  me  7  cases  known  in  the  State.  Only  one  was  isolated. 
All  the  others  were  able  to  attend  to  their  usual  business.  All 
were  Norwegians  and  males,  35  to  73  years  old,  and  affected 
with  leprosy  from  11  to  29  years.  Five  of  them  had  developed 
before  emigration  to  this  country.  Two  of  them  have  healthy 
children.  The  others  have  no  living  children.  Between  1868 
and  1889  there  had  been  19  deaths.  Dr.  G.  A.  Hansen,  Surgeon 
of  the  Bergen  (Norway)  Leper  Hospital,  in  a  recent  visit  to  the 
Northwestern  States,  estimates  that  there  were  only  16  or  17 
lepers  then  alive.  (Occi.  Med.  T.,  August,  1889.) 

In  a  book  entitled  "Concise  Natural  History  of  East  and 
West  Florida,"  published  at  New  York  in  1775  and  quoted  by 
Prof.  Joseph  Jones,  of  New  Orleans,  is  found  a  description  of  a 
disease  then  prevailing  among  the  negroes  which  was  probably 
leprosy.  The  evidence  that  the  malady  then  prevailed  in  the 
Spanish  Province  of  Louisiana  is  stronger.  Gayarre,  in  his 
history  of  Louisiana,  volume  3,  page  167,  says:  "One  of  the 
first  measures  of  Miro's  administration  was  one  of  charity.  It  is 
remarkable  that  leprosy,  which  is  now  so  rare  a  disease,  was 
then  not  an  uncommon  affliction  in  Louisiana.  Those  who 
were  attacked  with  this  loathsome  infirmity  ge,, >  fee-ally  congre- 
gated about  New  Orleans,  where  they  obtained  more  abundant 
alms  than  in  any  other  parts  of  the  Colony.  They  naturally 
were  objects  of  disgust  and  fear,  and  the  unrestrained  inter- 
course which  they  were  permitted  to  have  with  the  rest  of  the 
population  was  calculated  to  propagate  the  distemper.  Ullon 
(whose  administration  began  in  1766)  had  attempted  to  stop 
this  evil  by  confining  some  of  the  lepers  at  the  Belize  (mouth  of 
the  Mississippi  river),  but  this  measure  has  created  great  dis- 
comfort and  has  been  abandoned.  Miro  now  determined  to  act 
with  more  efficacy  in  this  matter,  and  on  his  recommendation 

12 


166  Leprosy. 

the  cabildo,  or  council,  caused  a  hospital  to  be  erected  for  the 
reception  of  these  unfortunate  beings  in  the  rear  of  the  city.  In 
the  course  of  a  few  years  the  number  of  these  patients  gradually 
diminished  either  by  death  or  transportation,  the  disease  dis- 
appeared almost  entirely,  and  the  hospital  went  into  decay." 

From  this  time  leprosy  appears  to  have  attracted  no  public  at- 
tention in  Louisiana  until  about  1879,  when  the  State  Medical 
Society  undertook  its  investigation.  At  that  date  Dr.  Salomon 
had  discovered  six  cases  in  New  Orleans,  and  six  more  were  re- 
ported in  Vermillion  Parish,  near  the  Gulf  of  Mexico.  This 
last  group  originated  with  a  woman  born  in  Louisiana,  whose 
father  came  from  the  South  of  France.  It  does  not  appear  that 
he  was  a  leper,  nor  is  there  evidence  of  leprosy  in  the  previous 
history  of  the  family.  The  woman  developed  the  malady  in  1866 
and  died  in  1870.  In  1880,  Prof.  Joseph  Jones,  then  President 
of  the  State  Board  of  Health  of  Louisiana,  visited  the  parish  of 
La  Fourche  and  there  found  another  group  of  twelve  cases. 
There  was  strong  evidence  that  the  disease  had  existed  for  sev- 
eral generations.  These  cases  in  the  two  country  parishes 
(counties)  were  all  French  Creoles  and  of  the  humblest  class  of 
white  people.  It  therefore  appears  that  at  least  eighteen  lepers 
were  found  in  Louisiana  in  1880,  with  a  strong  probability  that 
a  considerable  additional  number  remained  undiscovered.  A 
report  from  the  Louisiana  Board  of  Health  in  May,  1889,  gave 
twelve  cases  in  the  before  mentioned  parish  of  La  Fourche, 
three  positive  and  three  doubtful  cases  at  St.  Martinsville,  and 
forty-two  known  cases  at  New  Orleans.  It  is  remarked:  "  The 
cases  in  St.  Martinsville  are  all  descendants  of  one  man,  who 
died  some  years  ago  of  leprosy,  he  having  inherited  the  disease 
after  it  had  skipped  one  generation. " 

The  compiler  of  the  accompanying  table  of  cases  in  New 
Orleans,  being  the  clinical  lecturer  on  Dermatology  at  the 
Medical  College  and  Polyclinic,  and  Dermatologist  to  two  hos- 
pitals, has  unusual  opportunities  for  observation,  of  which  he 
has  fully  availed  himself.  It  is  probable  that  hardly  a  case  in 
that  city  has  escaped  his  notice,  and  that  the  majority  in  the 
State  have  come  under  his  eye.  It  is  to  be  noted  that  only  ten 
had  relatives  similarly  affected,  and  Dr.  Blanc  remarks:  "Some 
of  the  patients  have  had  perfectly  healthy  children  after  the  dis- 
ease began,  but  the  rule  seems  to  be  in  females  for  pregnancy 
to  end  in  miscarriage,  or  in  a  weak,  delicate  child."  To  this  it 
might  be  added  that  lepers  generally  lose  the  procreative  f  unc- 


Leprosy. 


167 


tion.  It  remains  to  say  that  there  are  no  legal  restrictions  over 
lepers  in  Louisiana,  and  that  they  are  received  into  the  New 
Orleans  Charity  Hospital,  and  placed  in  the  ordinary  surgical 
wards  with  other  patients.  This  practice,  however,  has  not 
the  approval  of  medical  men,  but  is  adopted  for  want  of  other 
provision. 

TABLE  OF  LEPERS  IN  NEW  ORLEANS,  1889 DR.  H.  W.  BLANC. 


i 

o 

a 
a 
< 

NATIVITY. 

COLOR. 

X 
K 

CO 

VARIETY 

NATIVITY  OF 
PARENTS. 

DURA- 
TION. 

RELATIVES 

WITH 

LEPROSY. 

1 

60 

Germany 

w 

f 

Anaes. 

Germany 

1  year 

2 

• 

16 
35 

New  Orleans 
Germany 

w 

\v 

in 

f 

Tub. 
M.  A. 

Germany 

2  years 
5  years 

4 

2<J 

New  Orleans 

w 

m 

T. 

3  years 

a 
*  / 

25 

Missouri 

w 

f 

T. 

7  years 

r 

26 

New  Orleans 

w 

f 

M.  T. 

Ireland 

7  years 

7 

26 

Louisiana 

hi 

f 

T. 

f  'thr  Italy,  mr  La 

3  years 

8 

75 

Louisiana 

w 

f 

M.  T. 

2  years 

c) 

48 

Germany 

w 

in 

M.  A. 

Germany 

5months 

10 

35 

Germany 

w 

in 

T.An, 

Germany 

10  years 

step  mother  & 
half  brothers 

11 

47 

Louisiana 

w 

f 

T. 

6  years 

12 

46 

Austria 

w 

m 

M.  A. 

Austria 

10  years 

13 

27 

New  Orleans 

w 

in 

T.  A. 

Ireland 

14  years 

14 

35 

New  Orleans 

w 

m 

M. 

18  m'ths 

15 

65 

Ireland 

w 

m 

M.  A. 

father  Ireland 

Ifi 

10 

New  Orleans 

w 

m 

T. 

Germany 

5  years 

17 

63 

Germany 

w 

m 

A. 

Germany 

18  m'ths 

18 

27 

New  Orleans 

w 

in 

T. 

mother 

19 

57 

Germany 

w 

f 

T.  A. 

Germany 

8  years 

20 

27 

New  Orleans 

w 

in 

M.  A. 

Ireland 

18  m'ths 

21 

24 

New  Orleans 

w 

in 

A. 

3  years 

uncertain 

22 

16 

New  Orleans 

\v 

in 

T.  A. 

fr  Ger.  mr  Ireland 

23 
24 

45 
17 

New  Orleans 
New  Orleans 

w 
w 

f 
f 

T. 
T. 

Mississippi,  N.  0. 

6  years 
4  years 

two  daughters 
m'thr  &  sister 

25 

15 

New  Orleans 

w 

f 

T. 

Mississippi,  N.  0. 

m'thr  &  sister 

26 

11 

Louisiana 

w 

m 

T. 

5  years 

27 

14 

New  Orleans 

w 

f 

M. 

4  years 

28 

16 

Louisiana 

w 

m 

T. 

Louisiana 

10  years 

father  &  sev'rl 
relatives 

2'J 

15 

New  Orleans 

w 

in 

T. 

5  years 

brother 

30 

13 

New  Orleans 

w 

m 

T. 

2  years 

brother 

31 

51 

England 

w 

111 

T. 

England 

5  weeks 

32 

28 

Louisiana 

1)1 

111 

A. 

3  years 

33 

54 

jrermany 

w 

in 

T. 

Grermany 

7  years 

34 

18 

New  Orleans 

w 

f 

T. 

r  German  m  N.  0. 

4  years 

35 

21 

Louisiana 

111 

m 

T. 

Louisiana 

1  year 

mother  suspi- 

cious 

36 

21 

tfew  Orleans 

w 

m 

T. 

[r  eland 

1  year 

37 

17 

New  Orleans 

w 

in 

T. 

jermany 

1  year 

38 

J6 

N"ew  Orleans 

w 

f 

M. 

:  France,  m  Cuba 

4  months 

.'{!) 

50 

Italy 

w 

m 

A. 

40 

45 

New  Orleans 

1)1 

f 

A. 

41 

18 

France 

w 

f 

A. 

sister 

42 

1!) 

New  Orleans 

u 

m 

A. 

168  Leprosy. 

Prof.  Joseph  Jones,  of  New  Orleans,  mentions  a  case  of  lep- 
rosy that  he  saw  less  than  forty  years  ago  among  negroes  on  the 
coast  of  Georgia,  who  had  been  brought  from  Africa.  The  dis- 
ease has  probably  disappeared,  as  there  are  no  recent  accounts 
of  it. 

Prof.  J.  C.  White  (Am.  J.  M.  Sci.,  Oct.,  '82)  gives  a  table  of  16 
cases,  compiled  by  Dr.  J.  F.  M.  Geddings,  of  Charleston,  S. 
C.,  iu  1876.  None  occurred  to  his  knowledge  subsequently  to 
1876,  and  at  that  date  all  were  known  to  be  dead  except  two, 
whose  fate  was  not  ascertained.  Of  these,  11  were  whites,  4 
mulattoes  and  J  black,  5  were  Jews,  1  Irish.  Fifteen  appear  to 
have  been  Native  Americans,  and  the  remaining  negro  may 
have  been.  All  occurred  between  1846  and  1876.  Dr.  Ged- 
dings remarks:  "I  can  form  no  opinion  as  to  when  the  disease 
first  made  its  appearance  in  South  Carolina.  The  first  case  could 
not  in  any  way  be  connected  with  the  old  cases  of  the  past  cen- 
tury iu  the  Gulf  States.  Both  of  the  first  cases  were  Jews  from 
families  coming  to  this  country  early  in  this  century.  Nor  could 
any  of  the  cases  have  had  any  connection  with  the  recently 
reported  occurrence  in  Louisiana,  or  from  African  descent 
through  slaves."  With  regard  to  connection  between  these 
cases  he  remarks:  "The  mulatto  named  Lazarus  is  said  to  be 
the  son  of  a  Jew;  the  others  are  of  uncertain  descent.  With 
the  exception  of  this  case  there  was  no  special  association."  It 
is  greatly  to  be  regretted  that  the  origin  of  these  cases  was  not 
discovered.  Dr.  T.  G.  Simmons,  of  Charleston,  a  member  of 
the  Slate  Board  of  Health,  informed  me,  in  September,  1888, 
that  there  had  recently  been  a  death  from  leprosy  in  that  city, 
and  that  he  knew  of  four  other  cases  there.  Dr.  W.  H.  Ged- 
dings, now  of  Aiken,  S.  C.,  but  formerly  of  Charleston,  in- 
forms me  that  he  bad  a  case  under  his  care  in  1884.  It  is  not 
stated  whether  these  recent  cases  have  any  connection  with  the 
above  mentioned  list  of  16  lepers. 

In  the  N.  Y.  Med.  Jour,  for  January  5,  1889,  the  surprising 
announcement  is  made  by  Dr.  Berger  of  100  cases  at  Key  West. 
It  seems  incredible  that  so  large  a  number  could  be  found  in  so 
small  a  population.  If  true,  it  must  have  existed  many  years, 
and  then  it  would  be  strange  for  such  a  spectacle  to  have 
attracted  no  attention. 

Dr.  Joseph  Y.  Porter,  M.  D.,  Secretary  and  Health  Officer, 
Florida  State  Board  of  Health,  in  reply  to  my  letter  of  March 


Leprosy.  169 

19,  1890,  regarding  the  above,  states  as  follows:  "Noting 
your  inquiries  I  would  say  that  some  years  ago,  possibly  two 
or  three,  there  were,  to  my  knowledge,  six  cases  of  leprosy  in 
Key  West.  At  that  time  the  State  had  no  board  of  health,  and 
my  attention  was  directed  to  the  existence  of  this  disease  by 
being  President  of  the  Board  of  Health  of  the  county  in  which 
Key  West  is  situated.  These  unfortunate  people  were  cared 
for  by  their  friends  and  were  isolated  from  the  rest  of  human 
kind,  therefore  I  did  not  think — nor  do  I  now — that  any  danger 
threatens  from  these  cases. 

"  It  is  well  known  that  leprosy  exists  to  quite  a  degree  in 
Havana,  and  for  that  reason,  some  years  before,  the  State  Board 
of  Florida  was  formed.  The  Board  of  Health  of  Monroe  county 
of  this  State  requires  that  passengers  from  Havana,  besides 
being  acclimated  to  yellow  fever,  should  also  present  a  certifi- 
cate of  exemption  from  leprosy,  which  certificate  was  to  be 
signed  by  Dr.  Burgess,  who  is  Sanitary  Inspector  of  Marine 
Hospital  Service  attached  to  the  U.  S.  Consulate  at  Havana. 

"  You  will  appreciate,  Doctor,  that  our  Board  of  Health  is 
still  in  its  infancy,  and  as  yet  has  not  had  sufficient  time  to 
thoroughly  take  up  this  point,  but  will  do  so  in,  I  might  say,  the 
immediate  future;  it  certainly  is  a  subject  that  should  not  be 
overlooked." 

Dr.  Geo.  H.  Fox  (Pop.  Sci.  Mo.,  Apr.,  '84)  asserts  that,  during 
the  last  ten  or  fifteen  years,  cases  of  leprosy  have  constantly 
been  present  in  the  New  York  Hospitals. ,  Dr.  E.  W.  Taylor 
(N.  Y.  Med.  Jour.,  July  13,  1889)  remarks  that  during  the  past 
fifteen  years,  he  has  seen  almost  constantly  one  to  three  lepers 
in  the  crowded  wards  of  the  hospitals  on  Blackwell's 
Island,  N.  Y. 

Dr.  Wm.  M.  Smith,  Health  Officer,  New  York,  through  Dr. 
Cyrus  Edson,  Chief  Inspector  San.  Bureau,  New  York,  in  reply 
to  a  letter  of  March  16,  says:  "  Careful  investigation  shows 
only  six  cases  of  leprosy  in  this  city  at  present.  Three  are  in 
public  institutions,  and  three  are  isolated  in  their  residences. 
During  the  past  ten  years  we  have  averaged  about  six  cases 
present  among  us  at  all  times." 

Dr.  Prince  A.  Morrow  states  that  leprosy  has  gained  a  foot- 
hold at  Salt  Lake  City  through  Mormon  converts  from  the 
Hawaiian  Islands.  (N.  Y.  Med.  Jour.,  July,  '89.)  In  confirma- 
tion, I  am  informed  by  Dr.  J.  M.  Benedict,  of  that  city,  that  he 


170  Leprosy. 

has  had  under  his  care  two  Kanaka  girls  for  leprosy.     Both  are 
now  dead. 

I  learn  that  16  Chinese  lepers  have  been  shipped  back  home 
from  Oregon  within  a  few  years.  As  to  the  States,  etc.,  not 
heretofore  mentioned,  there  is  said  to  be  a  case  of  leprosy  in 
Canada,  also  one  in  Arkansas;  one  has  been  reported  in  Miss., 
and  two  or  three  in  Texas.  Of  deaths  within  a  few  years,  there 
have  been  Sin  Iowa,  9  in  La.,  2  in  Mass.,  and  19  in  Minn. 

In  California  the  earliest  cases  were  Chinamen,  and  up  to  the 
present  time  the  great  majority  have  been  Chinese.  Owing  to 
their  migratory  habits,  it  has  been  impossible  to  enumerate  the 
lepers  correctly.  The  same  individuals  might  be  observed  in 
several  different  counties,  if  not  promptly  apprehended.  When 
sufficiently  advanced  in  the  disease  to  be  recognized  they  have 
mostly  drifted  to  San  Francisco,  and  found  their  way  to  the 
Twenty-sixth  Street  Hospital,  the  pest  house. 

The  majority  have  been  sent  back  to  China,  as  they  have  this 
option.  Through  correspondents  in  most  of  the  counties,  I 
have  been  able  to  learn  of  twenty  (20)  cases  under  their  observ- 
ation during  perhaps  as  many  years,  outside  of  San  Francisco, 
but  some  of  them  might  also  be  reckoned  there,  after  arrival  from 
the  country.  Six  deaths  are  known  to  have  occurred  outside  the 
metropolis,  but  it  is  probable  that  other  lepers  have  died  of 
intercurrent  diseases,  and  so  have  not  been  included.  The  law 
requires  all  cases  to  be  reported  by  the  local  authorities  to  the 
Secretary  of  State  who  is  to  keep  a  complete  register  of  them; 
but  no  penalty  is  provided  for  neglect,  and  the  duty  has  not 
been  performed. 

Most  of  the  white  lepers  trace  their  malady  to  the  Hawaiian 
Islands.  I  have  been  informed  by  Dr.  L.  L.  Dorr,  who  was 
Coroner  of  San  Francisco  from  1876  to  1881,  that  two  white 
lepers  came  under  his  official  notice  as  suicides.  Both  had  lived 
on  the  Hawaiian  Islands.  He  adds  that  it  has  been  customary 
there  to  allow  white  lepers  to  leave  the  country,  instead  of  going 
to  the  Molokai  settlement.  There  are  now  three  white  boys, 
brothers,  at  the  Twenty-sixth  Street  Hospital  who  contracted 
leprosy  on  the  Islands.  Their  father  lives  in  the  city  and  re- 
mains in  good  health. 

I  am  specially  indebted  to  Dr.  W.  F.  Finnie,  Resident  Phy- 
sician of  the  San  Francisco  City  and  County  Hospital,  for  the 
following  particulars,  which  he  has  compiled  with  great  pains 


Leprosy. 


171 


from  the  records   of  the   Twenty-sixth  Street  Hospital    (Pest 
House). 

Total  number  of  lepers  admitted  from  July  5,  1871,  to  April 
1,  1890,  128. 

Year    Admitted  Year      Admitted  Year      Admitted  Year      Admitted 

1871 1  1876 3  1882 12  1887 3 

1872  1  1878 13  1883 11  1888 3 

1873 1  1879 14  1884 9  1889 12 

1874 6  1880 10  1885 7  1890 5 

1875 9  1881 2  1886 6 

Nativity.  Number. 

China 114 

Honolulu 1 

United  States 3 

England 1 

Sweden , 1 

France 1 

Japan 1 

Germany 1 

Mexico 1 

Total 128 

Last  residence  other  than  San  Francisco: 

San  Quentin 1 

Monterey , 1 

Honolulu 5 

Merced 1 

Sacramento .  3 

New  York .' 3 

Los  Angeles 2 

Petaluma 1 

St.  Louis,  Mo ....    1 

Napa  City   1 

Dutch  Flat,  Placer  County 1 

Total 20 

Whites 12 

Mongolians 115 

Mixed 1 

Total 128 

Males 120 

Females 8 

Total . .  128 


172  Leprosy. 

Discharged 6 

Escaped 3 

Died 22 

Shipped  to  China 83 

Not  Noted 1 

Remaining  April  1,  1890 13 

Total 128 

Of  those  deceased,  three  were  suicides,  one  died  of  accidental 
suffocation,  and  one  of  small-pox. 

It  is  curious  that  the  records  of  the  City  and  County  Hospital 
give,  from  1871  to  1876  inclusive,  fifty-seven  cases  of  syphilis, 
with  sixteen  deaths;  while  from  1882  to  1890  there  were  forty 
cases  and  no  deaths.  Dr.  Finnie  reasonably  presumes  that  all, 
or  nearly  all,  of  the  sixteen  fatal  cases  were  leprosy. 

CASUAL    OR    SPORADIC. 

These  occasionally  turn  up  most  unexpectedly  in  places  where 
leprosy  has  always  been  unknown  or  rarely  observed.  They  are 
a  puzzle  to  medical  men  and  a  wonder  to  the  laity.  It  is  pro- 
bable that  they  often  pass  without  recognition,  for  the  great 
majority  of  physicians  are  strangers  to  the  disease  and  would 
mistake  it  for  something  else.  The  ordinary  sources  of  medical 
information  furnish  the  following.  In  England  most  of  them 
have  previously  resided  in  India  or  the  Colonies  where  leprosy 
prevails.  In  1873  Dr.  F.  E.  Anstie  presented  a  case  to  the 
Clinical  Society  of  London,  a  man  29  years  old,  who  had  resided 
11  years  in  India.  Three  others  had  previously  come  under  his 
notice.  The  same  year  Dr.  Tilbury  Fox  reported  a  girl  ten 
years  old,  who  was  believed  to  have  contracted  leprosy  from  her 
wet  nurse.  The  first  symptoms  appeared  when  she  was  between 
2  and  3  years  of  age.  In  1853  a  tailor,  native  of  Ireland,  died 
of  leprosy  at  Guy's  Hospital,  London,  after  an  illness  of  eight 
years.  He  was  never  out  of  the  British  Isles.  (Hed.  Chir.  Trans., 
1860.)  In  1872  an  Irish  leper  was  shown  to  the  Dublin  Medical 
Society,  who  had  contracted  the  disease  in  India.  For  a  year 
and  a  half  this  man's  brother,  who  had  only  left  Ireland  for  a 
visit  to  England  forty-six  years  before,  slept  in  the  same  bed 
and  -wore  his  clothing.  He  became  a  leper  and  was  presented 
to  the  same  Society.  There  were  no  other  lepers  in  the  family. 
(Report  Dr.  Lee  in  Nat.  Conf.  S.  B.  of  H.,  1888.) 


Leprosy.  173 

Cases  occasionally  present  themselves  at  hospitals  in  Boston, 
Philadelphia,  Baltimore  and  other  cities.  They  are  mostly  sail- 
ors, or  persons  who  have  lived  abroad.  A  case  of  leprosy  de- 
veloped in  the  almshouse  of  Salem,  Mass.,  in  the  person  of  a 
man  named  Chas.  Derby,  lately  from  San  Francisco.  He  had 
lived  some  years  at  Honolulu,  as  chief  botanist  to  Queen  Emma. 
(Med.  News,  Dec.  23,  1882.)  In  1889  Dr.  P.  S.  Abraham  pre- 
sented two  cases  to  the  Epidemiological  Society  of  London,  one 
tubercular,  the  other  anaesthetic.  The  latter  v.as  a  native  of 
London,  64  years  old,  who  had  been  a  sailor  in  the  Medit- 
erranean and  Baltic,  but  for  the  last  forty  years  had  not  been 
out  of  London.  He  was  a  meat  salesman.  Dr.  A.  thought  the 
period  of  incubation  must  have  been  nearly  forty  years.  He 
also  alluded  to  a  recent  case  brought  to  notice  at  Dublin. 

In  1889  Dr.  Geo.  Dock  reported  to  the  Texas  State  Medical 
Society  two  cases  of  leprosy,  of  tubercular  type,  one  of  8,  the 
other  of  5  years  standing;  one  a  native  of  Germany,  the  other  of 
Alsace;  one  a  harness  and  mattress-maker,  the  other  employed 
in  a  cotton  press.  Both  had  resided  at  Galveston  more  than 
20  years,  and  Dr.  D.  was  unable  to  trace  the  cause  either  through 
heredity  or  contagion.  Prof.  White,  of  Boston,  states  that  one 
of  the  Tracadie  cases  escaped  about  1857,  and  was  for  a  consid- 
erable time  at  Boston  under  an  assumed  name.  There  he  was 
under  the  doctor's  charge  for  months  at  the  Massachusetts  Gen- 
eral Hospital.  A  leper  from  Louisiana,  under  a  feigned  name, 
lived  near  Boston  and  came  under  his  care  -in  1882.  He  adds 
that  another  Tracadie  case  has  been  known  at  Boston,  and  one 
in  1882  was  discovered  at  Providence  and  returned  to  Tra- 
cadie. 

In  1888  a  leper,  in  company  with  another  Chinaman,  boarded 
a  train  at  Ogden.  His  case  was  recognized  by  a  physician,  who 
happened  to  be  aboard,  and  the  division  Superintendent  of  the 
C.  P.  R.  B.  was  notified;  but  he  refused  to  have  the  leper  re- 
moved from  the  train,  and  he  was  brought  to  San  Francisco. 
The  State  Board  of  Health  of  Missouri  in  1888  reported  the  dis- 
covery of  a  case  in  June,  1888.  He  had  lived  at  New  Orleans 
most  of  the  time  from  1866  to  1879,  and  leprosy  developed  in 
1881.  He  was  removed  to  the  quarantine  hospital  at  St.  Louis. 
In  Sept.,  1888,  two  Chinese  lepers  traveled  from  Los  Angeles  to 
San  Francisco,  having  been  sent  by  their  countrymen  without 
knowledge  of  the  authorities.  On  arrival  at  San  Francisco  they 


174  Leprosy. 

were  recognized  as  lepers  and  sent  to  the  Twenty-sixth  Street 
Hospital.  Late  in  1889  two  Chinese  lepers  traveled  by  rail  from 
New  York  to  San  Francisco.  One  came  with  a  certificate  to  the 
Health  Officer  at  San  Francisco,  that  he  was  affected  with  lep- 
rosy, and  a  request  that  "good  care  be  taken  of  him." 

The  Occidental  Med.  Times  of  July  1,  1889,  gives  the  case  of  a 
leper  committed  to  the  Sacramento  County  Jail,  in  an  advanced 
stage  of  leprosy.  He  was  pardoned  by  the  Governor,  so  that 
he  might  be  sent  to  the  Twenty-sixth  Street  Hospital  at  San 
Francisco.  Dr.  David  Powell,  of  Marysville,  Yuba  County, 
California,  kindly  reports  to  me  the  case  of  a  mulatto  barber  of 
that  place,  aged  60,  who  committed  suicide  in  1888,  on  discover- 
ing himself  to  be  a  leper.  He  was  a  native  of  Virginia,  and 
had  not  been  away  from  Marysville  for  25  years.  Symptoms  of 
leprosy  appeared  in  1884,  but  he  continued  to  work  at  his  trade 
long  after.  Dr.  C.  E.  Stone,  President  of  the  local  Board  of 
Health,  surmises  that  he  might  have  contracted  the  disease 
from  Chinese  women.  Dr.  F.  B.  Sutliff,  of  Sacramento,  in- 
formed me  about  a  year  ago,  that  three  cases  of  leprosy  had 
come  under  his  personal  observation,  in  his  own  community,  all 
of  the  tubercular  type  and  all  at  large.  Dr.  J.  L.  Babcock 
(N.  Y.  Med.  Bee.,  Sept.,  1888)  states  that  three  cases  occurred 
at  St.  Louis  in  1888.  In  May,  1888,  I  myself  saw  a  young  man 
on  the  streets  of  Los  Angeles,  who  presented  the  appearance  of 
a  leper,  but  there  was  no  opportunity  for  thorough  examination. 
The  writer  of  an  article  in  the  editorial  page  of  the  Pac.  Med. 
and  Surg.  Jour,  for  August,  1888,  states  that  he  saw  a  China- 
man on  the  street  in  the  Chinese  quarter  of  San  Francisco  a  few 
months  previously,  who  was  obviously  a  leper,  but  not  in  a  very 
advanced  stage.  In  the  month  of  February,  1890,  no  less  than 
three  lepers,  all  white  men,  have  been  apprehended  at  San 
Francisco  and  sent  to  the  Twenty-sixth  Street  Hospital.  One, 
a  teamster,  forty-one  years  old,  has  been  affected  seven  years, 
and  has  been  twice  at  the  hospital  before,  but  escaped.  An- 
other, now  twenty-one  years  old,  lived  for  some  years  at  Hono- 
lulu, and  has  been  affected  several  years.  The  third,  a  native  of 
Guatemala,  fourteen  years  old,  and  one  year  resident  of  San 
Francisco,  employed  as  a  dishwasher  at  various  restaurants.  He 
has  been  a  leper  for  three  years. 


Leprosy.  175 

CAUSES  DETERMINING  LEPBO8Y. 

Twenty  years  ago  writers  on  this  subject  were  much  inclined 
to  ascribe  the  disease  to  endemic  causes,  such  as  proximity  to 
the  sea  coast,  low  altitudes  above  sea  level,  high  temperature, 
excess  of  moisture  in  the  atmosphere,  etc.  It  is  found,  how- 
ever, that  the  malady  prevails  where  all  these  conditions  are 
absent.  A  fish  diet  has  been  accused  by  many  writers  of  being 
the  cause,  but  the  Hindoos  of  the  interior  rarely  eat  fish.  In 
India  it  has  been  attributed  to  deficiency  of  salt  in  food,  because 
the  poorest  people  at  the  same  time  abstain  most  from  taxed 
salt  and  furnish  most  cases  of  the  malady.  Elsewhere  no  one 
has  thought  of  this  as  a  cause.  It  is  true  that  leprosy  attaches 
most  to  people  lowest  in  the  scale  of  intelligence,  of  wealth  and 
the  comforts  of  life.  Such  people  live  most  crowded  in  their 
habitations,  particularly  in  their  beds,  and  eat  with  their  fingers 
from  a  common  dish.  They  have  too  little  clothing  to  allow 
frequent  changes  and  clean  attire,  soap  is  little  used,  and  per- 
sonal cleanliness  neglected.  All  these  conditions  favor  conta- 
gion, and  it  is  found  that  contrary  conditions  are  attended  with 
proportional  exemption  from  the  disease.  The  improved  con- 
dition of  Norwegian  immigrants  in  this  country,  rather  than  any 
difference  in  the  climate,  has  resulted  in  the  moderation  and 
gradual  disappearance  of  leprosy. 

Until  ten  or  fifteen  years  ago  most  writers  of  the  present  age 
regarded  heredity  as  the  chief  factor  in  the  production  of  this 
disease,  and  many  still  adhere  to  the  belief.  It  is,  however, 
rapidly  losing  ground,  and  there  are  some  who  are  disposed  to 
estimate  it  of  little  or  no  force.  Inasmuch  as  at  least  a  major- 
ity of  the  children  of  lepers  fail  to  take  the  disorder,  all  must 
admit  that  the  influence  is  weak.  "What  becomes  of  heredity 
among  the  children  of  Norwegian  immigrants  in  the  States  of 
Wisconsin,  Iowa  and  Minnesota  ?  Two  hundred  lepers  in  the 
first  generation,  afford  only  one  in  the  second  generation  dur- 
ing 50  years.  Dr.  White  states  that  in  1848,  eleven  inmates  of 
the  Tracadie  Asylum  had  altogether  sixty-three  children,  none 
of  whom  were  diseased.  On  the  other  hand  the  rapid  spread 
of  leprosy  in  the  Sandwich  Islands  between  1860  and  1875 
makes  it  impossible  that  any  considerable  proportion  could 
have  inherited  the  taint.  Aside  from  the  mortality  due  to  this 
malady,  the  native  population  there  is  rapidly  diminishing  and 
it  is  found  that  lepers  have  few  children,  most  of  whom  are 


176  Leprosy. 

either  born  dead  or  die  youug.  According  to  Dr.  GK  L.  Fitch, 
who  lived  several  years  at  the  Islands  and  who  must  have  had 
abundant  means  of  observation,  of  twenty-six  children  born  at 
the  Molokai  settlement,  of  parents  one  or  both  leprous,  and 
aged  from  twenty-one  months  to  fourteen  years,  only  two  were 
lepers  in  1884,  but  Dr.  Mouritz,  two  years  later,  found  nine  lep- 
ers among  them.  Contagion  was  doing  its  work.  The  group  of 
sixteen  cases  at  Charleston  could  not  be  accounted  for  by  hered- 
ity, for  the  Jews  belonged  to  three  different  families,  and  there 
were  besides  Irish,  native  whites  and  blacks;  neither  did  hered- 
ity succeed  in  perpetuating  the  disorder.  In  only  a  very  small 
number  of  the  forty-two  cases  now  at  New  Orleans  does  Dr. 
Blanc  succeed  in  finding  lepers  among  their  relatives,  either  as 
antecedents  or  descendants.  Of  course  it  is  out  of  the  question 
that  heredity  could  have  played  any  part  among  the  white  lep- 
ers of  the  Sandwich  Islands,  of  whom  sixteen  had  been  sent  to 
the  leper  settlement  previous  to  1880.  The  advocates  of  hered- 
ity agree  that  it  is  much  stronger  in  the  maternal  than  the  pater- 
nal line,  but  offer  no  explanation.  It  is  evident  that  children 
are  in  far  closer  social  relation  with  the  mother  than  with  the 
father,  especially  during  the  first  eighteen  months  of  life,  so 
that  the  chance  of  contagion  would  operate  in  the  same  degree. 
Instances  are  given  of  skipping  over  one  generation  in  heredi- 
tary transmission.  It  often  happens  that  children  are  special 
favorites  of  grand  parents,  and  are  in  closer  relation  with  them 
than  their  parents.  It  would  be  interesting  to  note  whether 
atavism  in  leprosy  could  actually  be  explained  in  this  way.  In 
my  judgment  it  is  quite  easy  to  account  for  the  cases  that  occur 
in  the  same  family  otherwise  than  by  inheritance,  for  there  are 
more  opportunities  for  contagion  in  the  household  than  else- 
where. Therefore,  without  totally  rejecting  the  influence  of 
heredity  I  should  say  that,  in  our  present  knowledge,  it  is  not 
necessary  to  invoke  it.  The  real  test  would  be  to  remove  im- 
mediately after  birth  a  number  of  children  from  leprous  parents, 
and  strictly  guard  them  against  contagion.  Then  if  any  of  them 
should  become  lepers  there  would  be  satisfactory  evidence  of 
inheritance.  Such  a  test  has  not  yet  been  afforded,  but  it  may 
soon  be  supplied  in  the  Kapiolani  Home,  devoted  to  the  care  of 
girls,  the  children  of  lepers,  not  yet  confirmed  as  lepers  them- 
selves, and  others  suspected  of  the  disease,  which  was  opened 
in  the  Hawaiian  Islands,  in  November,  1885. 


Leprosy '.  177 

The  notion  that  leprosy  is  an  offshoot  or  form  or  stage  of 
syphilis,  probably  originated  in  India,  where  it  is  entertained  by 
many  native  and  a  few  European  physicians. 

So  far  as  I  have  learned,  only  two  medical  men,  who  have 
lived  on  the  Sandwich  Islands,  hold  this  opinion,  namely,  Drs. 
George  L.  Fitch  and  F.  H.  Enders,  and  the  latter  is  by  no 
means  positive.  Dr.  Fitch's  theory  of  leprosy  is  thus  enunciated 
(Pacific  Medical  and  Surgical  Journal,  October,  1885):  "I  be- 
lieve myself  to  be  fully  justified  in  saying  that  leprosy  is  a  dis- 
ease which  cannot  be  communicated  from  a  leper  to  any  other 
person  by,  through  or  under  any  combination  of  circumstances 
except  heredity;  and  that  even  this  plays  but  little  part  in  the 
propagation  of  the  disease  we  may  know  from  the  fact  that  from 
1866,  when  Kalawao  settlement  was  first  founded,  until  March 
1, 1884,  2,941  lepers  were  consigned  there,  and  up  to  October  9, 
1884,  only  twenty-six  children  born  in  the  settlement  were  alive 
where  either  parent  was  a  leper  before  the  birth  of  the  child. 
*  *  *  Suffice  to  say,  that  I  fully  believe  leprosy  to  be  a  fourth 
stage  of  syphilis,  or  form  of  scrofula  subsequent  to  syphilis, 
occurring  but  rarely  except  in  a  virgin  race,  or  contracted  from 
a  member  of  such  race;  and  then  only  in  a  person  of  a  broken 
down  or  cachectic,  nervous  constitution,  and  rarely  met  with 
among  Anglo  Saxon  or  Celtic  races,  except  in  blonds."  Per 
contra,  Drs.  Arning  and  Emerson  aver  that  persons  contract 
leprosy  whose  parents  were  free  of  it,  and  who  have  never  had 
syphilis.  It  would  be  violence  to  all  probability  to  suppose  that 
the  leprosy  of  Fathers  Damien  and  Gregory,  of  the  Hawaiian 
Islands,  and  of  Father  Bogliori,  of  New  Orleans,  who  became 
diseased  while  in  discharge  of  their  sacred  functions,  was  due  to 
syphilis,  either  inherited  or  acquired. 

This  theory  of  the  identity  or  relationship  of  the  two  maladies 
must  have  arisen,  both  in  India  and  the  Islands,  from  their  joint 
prevalence  in  those  countries,  und  their  associations  in  many 
individuals.  Dr.  Fitch  lays  great  stress  upon  his  failure  to 
gyphilize  several  lepers  by  inoculation  with  syphilitic  virus. 
This  is  explained  by  their  being  already  syphilitic,  as  the  major- 
ity of  the  natives  of  the  Islands  are  said  to  be. 

Let  us  now  note  the  history  of  the  two  diseases.  Leprosy  has 
prevailed  in  the  Old  World  from  time  immemorial.  Constitu- 
tional syphilis  is  not  known  to  have  existed  in  the  Eastern  Hem- 
isphere before  the  discovery  of  the  New  World  by  Columbus; 


178  Leprosy. 

but  it  is  certain  that  within  a  few  years  after  it  seized  on  all 
classes  of  people  in  Italy  and  Spain,  and  rapidly  spread  over 
Europe.  It  was  a  terrible  stranger,  and  its  ravages,  both  in 
extent  and  severity,  were  like  those  of  small-pox  among  the 
American  aborigines,  and  leprosy  among  the  Hawaiians.  There 
is  abundant  mention  of  venereal  sores  and  gonorrhoea  in  ancient 
literature,  but  nothing  like  constitutional  syphilis  was  described 
till  within  ten  years  of  the  close  of  the  fifteenth  century,  or  after 
the  first  visit  of  Columbus  to  America. 

On  the  other  hand,  there  is  no  proof  that  leprosy  existed 
among  the  aborigines  of  America  before  1492.  Again  it  is  said 
that  syphilis  has  long  been  prevalent  in  Kamtchatka,  but  leprosy 
is  not. 

Dr.  M.  Hagan,  of  Los  Angeles,  who  formerly  resided  in  the 
Sandwich  Islands,  says:  "It  has  been  settled  beyond  dispute 
that  a  leper  will  contract  syphilis  and  recover  from  it  with  proper 
treatment,  while  the  original  disease  goes  on  and  ends  in  death." 
At  least  ninety-five  per  cent  of  syphilitic  cases  can  be  thoroughly 
cured  by  proper  treatment  sufficiently  prolonged,  but  the  reme- 
dies which  control  it  are  powerless  in  leprosy.  On  the  other 
hand,  the  remedies  which  stay  the  progress  of  leprosy  have 
gained  no  success  in  syphilis.  The  heredity  of  uncured  syphilis 
is  undisputed,  and  generally  apparent  at  birth;  that  of  leprosy, 
if  real,  never  appears  till  there  has  been  opportunity  for  conta- 
gion, and  a  sufficient  period  of  incubation. 

In  1867  the  Royal  College  of  Physicians,  of  London,  published 
their  famous  -opinion  in  opposition  to  the  contagiousness  of 
leprosy,  "on  hearsay  evidence;"  which  opinion  has  governed 
the  action  of  the  British  Government  ever  since,  and  has  exerted 
a  world- wide  influence. 

In  the  discussion  before  the  French  Academy  of  Medicine  in 
1885,  only  three  French  physicians  held  the  doctrine  of  conta- 
gion, but  in  1888  the  number  was  much  larger.  (Dr.  P.  A. 
Morrow,  New  York  Medical  Journal,  July  29,  1889.)  It  is  en- 
couraging to  note  that  the  Committee  on  Leprosy  of  the  Eoyal 
College  of  Physicians  has  recently  recommended  another  investi- 
gation of  the  subject.  In  China  and  India  leprosy  prevails  as  of 
old,  where  repression  has  never  been  tried  effectually.  In 
Europe  the  plan  of  segregation  during  the  thirteenth,  fourteenth 
and  fifteenth  centuries  nearly  eradicated  the  malady.  For 
want  of  such  repression  leprosy  is  now  increasing  in  most 


Leprosy.  179 

of  the  British  Colonies.  New  Brunswick  is  a  notable  exception. 
Dr.  Haiisen  remarks:  "  I  have  met  with  families  of  which  only 
those  members  became  leprous  that  had  emigrated  to  places 
where  leprosy  prevailed.  The  members  that  remained  at  home 
did  not  catch  the  disease."  With  due  regard  to  cleanliness  and 
avoidance  of  all  secretions  and  exudations  from  lepers  he  thinks 
there  is  no  danger. 

Proofs  of  communication  through  contagion  are  innumerable . 
There  is  no  other  way  to  account  for  the  rapid  spread  of  leprosy 
in  the  Hawaiian  Islands ,  and  especially  its  contraction  by  white 
residents.  For  example,  Dr.  A.  W.  Saxe,  in  a  paper  read  to  the 
California  State  Medical  Society  in  1881,  gave  an  instance  of 
three  children  of  American  parents,  who  remained  healthy, 
having  become  lepers  in  Honolulu.  Their  mother  did  not  nurse 
them,  and  they  evidently  were  somewhat  inoculated  by  a  native 
wet  nurse  or  some  leprous  playmate.  The  supposition  that  the 
disease  existed  among  the  indigenous  Mexicans  is  probably  a 
mistake,  for  the  aboriginal  race  are  free  of  it,  except  where  they 
have  lived  in  close  relation  with  the  whites  or  negroes,  as  in  those 
regions  settled  by  the  Spaniards  and  Portuguese.  It  is  much 
more  likely  that  American  leprosy  was  derived  from  Europe  and 
Africa.  No  heredity,  nor  syphilis,  nor  endemic  conditions  could 
have  given  rise  to  the  group  of  sixty  cases  in  the  village  of  Spain, 
to  the  outbreaks  in  New  Brunswick  and  Cape  Breton  Islands,  to 
the  sixteen  cases  at  Charleston  between  1846  and  1876,  to  the 
forty-two  now  at  New  Orleans,  or  to  the  two  at  Galveston.  It 
is  often  impossible  to  trace  the  source  and  mode  of  contagion, 
but  the  same  is  true  with  all  the  disorders  whose  contagiousness 
is  undisputed. 

Besides,  we  have  the  evidence  of  inoculation,  which  is  incon- 
trovertible. Dr.  Fitch  gives  some  instances  of  failure,  and 
adduces  the  convict  Keanu,  who  was  inoculated  at  the  Sandwich 
Islands  by  Dr.  Arning  in  1884,  as  an  alternative  to  the  death 
penalty;  but  the  man  died  of  leprosy  since  Dr.  Fitch  wrote,  and 
some  of  his  other  instances  may  result  in  like  manner.* 


*As  to  Keanu,  Dr.  Arning  supposed  that  there  had  been  no  leprosy  pre- 
viously in  his  family,  but  Dr.  S.  B.  Swift,  resident  physician  at  the  Molokai 
settlement,  avers  that  this  man's  son  and  sister's  son  were  both  lepers  before 
his  inoculation.  (Occidental  Medical  Times.}  Consequently,  it  is  possible  that 
Keanu  may  have  contracted  leprosy  in  the  natural  way,  though  the  bacilli 
were  found  at  the  point  of  inoculation  for  more  than  a  year  afterwards. 


180  Leprosy. 

Dr.  J.  C.  Tache,  of  Canada,  relates  the  following:  "At  the 
funeral  of  one  of  the  first  lepers  at  Tracadie,  a  young  man  who 
helped  carry  the  coffin  on  his  shoulder  received  an  abrasion  of 
the  skin  from  its  sharp  edge.  There  was  a  flow  of  liquid  from 
the  coffin  which  wet  the  abraded  spot,  and  he  had  no  opportu- 
nity for  several  hours  to  change  his  clothing  or  cleanse  himself. 
He  had  no  hereditary  taint,  but  died  a  leper  within  a  few  years. 

Dr.  A.  C.  Smith,  of  Newcastle,  N.  B.,  relates  the  case  of  a  boy, 
now  far  advanced  in  leprosy,  who  at  three  years  of  age  was 
waited  on  by  a  leprous  woman  while  he  was  in  the  healing  stage 
of  a  burn.  There  had  been  no  leprosy  in  his  family.  Dr. 
Hansen,  surgeon  to  the  leper  hospital  at  Bergen,  has  published 
some  cases  where  inoculation  has  take  place.  Dr.  Saxe  gives 
the  case  of  a  physician's  son  who  acquired  the  disease  after  in- 
serting a  pin  into  his  leg  which  a  little  Hawaiian  leper  had  just 
previously  thrust  into  an  anaesthetic  patch  on  his  own  leg.  (Prof. 
White,  American  Journal  of  Medical  Science,  October,  1882.) 
Dr.  Hillebrand  relates  this  occurrence  in  Borneo:  A  colored 
leprous  boy  ran  a  knife  into  an  anaesthetic  part  of  his  body,  his 
white  playmate  then  ran  the  same  knife  into  his  own  flesh.  The 
white  boy  went  to  Europe,  and  nineteen  years  after  developed 
leprosy.  It  has  been  suggested  that  leprosy  might  be  inocu- 
lated by  the  bites  of  flies  and  mosquitoes  coming  from  leprous 
sores,  and  it  is  supposed  by  Dr.  Manson  that  elephantiasis 
arabum  is  communicated  in  this  way.  The  supposition  is  cer- 
tainly more  probable  with  the  former  than  the  latter,  and  might 
account  for  some  mysterious  cases. 

It  is  important  to  make  a  distinction  between  contagion  and 
infection.  Unfortunately  there  is  a  want  of  precision  in  their 
definitions,  and  great  confusion  in  the  use  of  the  terms.  Here 
I  would  suggest  that  we  understand  contagion  to  mean  the 
reception  of  a  disease  poison  through  some  solution  of  contin- 
uity, and  infection  its  absorption  through  an  unbroken  surface. 
Contagion  would  therefore  mostly  operate  by  immediate  appli- 
cation of  virulent  matter  to  an  external  abraded  spot;  and 
infection  commonly  be  produced  on  respiratory  surfaces  through 
the  medium  of  the  atmosphere.  The  same  distinction  would 
apply  to  microbes  in  the  alimentary  canal  and  on  the  genito- 
urinary parts.  It  follows,  therefore,  that  infectious  diseases 
only  are  liable  to  become  epidemic.  In  this  sense  leprosy 
would  be  contagious  but  not  infectious,  since  it  is  probably 


Leprosy.  181 

necessary  for  the  virus  to  come  in  contact  with  an  exposed 
capillary  surface,  in  order  to  be  absorbed.  This  is  indicated  by 
the  safety  of  persons  casually  meeting  lepers,  and  it  explains 
the  fact  that  individuals  have  lived  in  intimate  relations  with 
lepers  for  years  without  harm.  Proof  of  the  absolute  non-con- 
tagiousness of  leprosy  is  claimed  from  the  well-known  and 
numerous  instances  of  escape  during  many  years  of  married  life 
between  lepers  and  non-lepers.  Safety  is  attributable  to  a 
sound  skin  or  failure  to  apply  the  virus  to  an  absorbing  surface. 
The  contagiousness  of  syphilis  is  never  questioned,  but  it  is 
probably  not  communicated  through  a  sound  mucous  surface, 
for  many  incontinent  men  have  always  escaped  it.  The  ex- 
planation that  sexual  relations  with  lepers  is  less  dangerous 
than  with  syphilitics,  is  the  fact  that  leprosy  is  not  apt  to  attack 
the  generative  organs. 

The  period  of  incubation  is  probably  rather  indefinite.  Most  N> 
writers  say  from  five  to  ten  years,  but  it  is  often  less.  In  the 
case  of  a  man  inoculated  by  Dr.  Arning  there  were  manifest 
symptoms  of  leprosy  within  three  years,  and  the  young  man 
mentioned  by  Dr.  Tache  began  to  complain  within  a  year  but 
lived  about  eleven  years.  It  is  not  improbable  that  there  was 
a  mistake  in  the  period  of  incubation  given  for  the  first  com- 
munication of  the  malady  at  the  little  village  in  Spain,  pre- 
viously mentioned  as  only  a  few  months;  it  might  have  been 
longer.  Dr.  Hansen  mentions  the  case  of  a  Hollander  who  became 
a  leper  ten  years  after  his  return  from  the  West  Indies.  I  have 
already  mentioned  a  case  in  this  paper  in  which  the  latent 
period  was  supposed  to  be  forty  years,  but  this  seems  incred- 
ible. 

As  to  sex,  the  common  opinion  is,  that  males  are  considerably 
in  excess  of  females.  This  is  probably  correct,  though  females 
in  the  seclusion  of  home  would  be  more  apt  to  escape  observa- 
tion. But  it  is  plain  that  men  and  boys,  being  more  away  from 
home,  in  all  sorts  of  company,  would  be  more  exposed  to  conta- 
gion. With  heredity  as  the  prevailing  cause  there  should  be 
no  such  marked  sexual  selection. 

It  is  agreed  that  the  majority  of  cases  begin  between  the  ages 
of  fifteen  and  forty  years,  which  is  the  period  of  greatest  activity 
and  exposure.  Under  three  years  of  age  it  is  extremely  rare. 
Dr.  Fitch  has  not  known  a  case  before  the  commencement  of 
second  dentition,  but  Arning  in  the  Sandwich  Islands,  and 

13 


182  Leprosy. 

Kynsey  in  Ceylon,  have  seen  it  at  three  years.  Dr.  Torrens 
has  observed  it  in  infancy  in  the  Canary  Islands,  but  the  precise 
age  is  not  given.  We  may  safely  conclude  that  there  is  always 
time  for  a  reasonable  incubation  after  exposure. 

The  natural  duration  of  leprosy  varies  with  the  type  and  cir- 
cumstances influencing  progress.  Lewis  and  Cunningham  give 
the  average  duration  of  the  tubercular  form  in  India  as  six  years 
shorter  than  that  of  the  anaesthetic,  and  fourteen  years  for  cases 
in  general.  Dr.  Graham  (Wood's  Hand  Book)  states  that 
leprosy  usually  proves  fatal  in  seven  or  eight  years.  Danielson 
and  Boeck,  of  Norway,  give  the  average  duration  as  eight  or 
nine  years  for  the  tubercular  type,  and  eighteen  or  nineteen  for 
the  anaesthetic,  but  sometimes  prolonged  to  forty  years.  Dr. 
Arning  in  1888  gave  the  duration  from  five  to  ten  years,  but 
Dr.  Hillebrand  whose  experience  in  the  islands  dated  fifteen 
years  earlier,  put  it  at  three  to  five  years.  It  is  always  under- 
stood that  cases  of  mixed  type  have  a  progress  slower  than  the 
tubercular  and  faster  than  the  anaesthetic. 

The  circumstances  modifying  leprosy  are  numerous  and  vary- 
ing in  effect.  Any  causes  which  lower  the  standard  of  health, 
like  previous  sickness,  deficiency  or  bad  quality  of  food,  expos- 
ure to  bad  weather,  excessive  exertion,  sexual  excesses;  intem- 
perance, living  in  close  and  crowded  apartments,  deficiency  of 
clothing  for  change,  neglect  of  ablutions,  all  favor  both  the 
contraction  and  rapid  progress  of  the  disorder.  Improvement 
in  all  these  respects  accounts  for  the  development  of  new  cases 
among  Norwegian  immigrants,  and,  with  a  single  exception,  of 
the  exemption  of  their  progeny  in  the  United  States. 

Admitting  the  contagiousness  of  leprosy,  it  is  probable  that 
it  varies  greatly  in  degree  among  different  individuals  and  races, 
as  is  true  of  other  diseases.  Dr.  Mouritz  concludes  that  about 
eighteen  per  cent  of  the  islanders  resist  contagion  totally,  judg- 
ing from  his  experience  at  the  Molokai  settlement.  It  is  doubt- 
ful whether  one  per  cent  would  resist  intentional  inoculation. 
Where  the  disease  has  prevailed  for  thousands  of  years,  as  in 
Egypt,  India  and  China,  and  where  the  anaesthetic  is  the  pre- 
vailing type,  the  principle  of  natural  selection  and  survival  of 
the  fittest  would  gradually  increase  the  resistance^of  the  people 
and  in  time  those  races  might  become  exempt.  In  the  absence 
of  effective  repressive  measures,  the  population  must  otherwise 
have  greatly  diminished.  The  same  seasoning  for  ages  of  the 


Leprosy.  183 

natives  of  those  countries  likewise  explains  the  protracted 
course  of  the  disorder.  Without  such  acquired  resistance,  and 
in  the  absence  of  repressive  measures,  its  ravages  would  equal 
what  was  experienced  in  Europe  in  the  twelfth,  thirteenth  and 
fourteenth  centuries. 

Without  apprehending  a  high  degree  of  contagiousness  for 
leprosy,  or  great  risk  in  ordinary  intercourse,  it  is  clear  that 
serious  danger  often  lurks  in  unexpected  quarters.  Two  priests 
and  one  physician,  Dr.  Edward  Hoffman,  undoubtedly  con- 
tracted it  on  the  islands,  while  pursuing  their  ordinary  avoca- 
tions; also  a  priest  at  New  Orleans.  What  might  have  hap- 
pened— indeed  may  already  have  been  incurred  here  in  Califor- 
nia— from  the  Marysville  barber  who  continued  to  shave  men's 
faces  for  years  after  he  became  a  leper;  from  the  San  Francisco 
teamster  who  escaped  and  pursued  his  regular  business  more 
than  two  years;  from  a  far  advanced  case  lately  found  in  a 
Chinese  laundry  at  Sacramento;  from  an  escaped  leper  sup- 
posed now  to  be  engaged  in  fishing  in  the  river,  from  two  Chi- 
nese cooks  and  a  Mexican  dishwasher  sent  to  the  San  Francisco 
Pest-house  within  the  past  year  !  Probably  not  one  of  these 
individuals  could  point  out  the  particular  source  of  his  own 
taint;  more  than  possible  other  mysterious  cases  may  follow 
them,  like  lengthened  shadows  to  a  hopeless  doom.  In  fact,  an 
instance  has  actually  occurred  in  California  of  a  white  boy,  now 
a  leper,  whose  father  has  employed  Chinese  both  on  his  ranch 
and  in  his  house,  some  of  whom  are  said  to  have  had  a  cutaneous 
disorder. 

BACILLUS   LEPB.E. 

The  credit  of  first  discovery  of  the  Bacillus  Lepree  is  given  to 
Hanson,  of  Bergen,  of  date  varying  from  1869  to  '74,  according 
to  different  writers. 

In  1879  Neisser  announced  an  independent  discovery.  The 
latter  has  inoculated  rabbits  and  dogs  with  leprous  matter  and 
so  produced  inflammatory  nodes  corresponding  to  human  lep- 
rosy. He  supposes  that  the  spores  enter  the  system  and  develop 
wherever  they  find  a  suitable  nidus,  especially  in  the  lymphatic 
glands.  Thence  they  invade  the  entire  body.  Eichhorst  states 
that  artificial  inoculation  of  animals  has  failed,  and  this  has 
been  Arning's  experience  in  the  Hawaiian  Islands.  Neisser, 
Damsch  and  Vossins  have  succeeded  in  the  culture  of  the  bacilli 
at  the  infected  spots.  The  bacilli  are  found  in  the  skin,  mucous 
membranes,  peripheral  nerves,  lymph-glands,  testes,  liver, 


184  Leprosy. 

spleen  and  eyes,  also  in  the  blood,  usually  enclosed  in  white 
blood  corpuscles.  From  the  Annual  of  Universal  Med.  Sci.  for 
1888  (Sajous)  I  condense  the  following.  The  bacilli  leprse  have 
never  yet  been  found  in  the  blood.  When  introduced  into  the 
circulation  these  organisms  probably  are  rapidly  carried  to  the 
capillaries  and  thence  by  diapedesis  to  lymph  spaces,  where 
they  set  up  the  characteristic  changes.  Lymph  may  contain 
bacilli.  Glandular  secretions  and  excretions,  notably  the  urine, 
are  almost  entirely  free.  Tears,  the  nasal  secretion  and  the 
saliva  swarm  with  them  whenever  the  ocular,  nasal  or  bucco- 
pharyngeal  surfaces  are  lepromotous;  also  the  alvine  discharges 
in  leprous  diarrhea.  When  the  testes  are  involved,  the  semen 
contains  bacilli.  The  uterine  mucus  and  vaginal  secretions 
never  do.  Vaccinal  lymph  from  lepers  contain  them.  Leprosy 
may  almost  certainly  be  conveyed  from  venereal  sores.  The 
lymphatic  and  ganglia  are  characteristic  and  constant  foci  of 
the  bacilli.  The  central  nervous  system  is  not  affected  by  lep- 
rosy, as  it  is  by  syphilis.  There  are  two  methods  of  conveying 
disease  through  bacteria:  1.  By  direct  contact  or  inoculation. 
2.  Indirectly  through  soil,  air,  water  or  food.  Arning  has  suc- 
ceeded with  the  former  mode,  but  failed  with  the  latter  in  his 
experiments  with  leprosy.  (This  indicates  that  leprosy  is  con- 
tagious but  not  infectious.) 

Dr.  Edw.  E.  Arning,  by  invitation  of  the  Hawaiian  Govern- 
ment, pursued  the  study  of  leprosy  in  the  islands  from  1883  to 
'85.  The  following  is  a  brief  abstract  of  his  observations  in  its 
bacteriology.  He  found  B.  in  the  trunks  of  nerves  supplying 
anaesthetic  patches,  but  not  in  the  patches  themselves,  nor  in 
chronic  sores  resulting  therefrom.  No  B.  in  blood  or  urine. 
They  were  found  in  the  nodules  of  the  tubercular  form.  Cul- 
ture experiments  failed  to  reproduce  B.  Inoculation  failed  to 
prove  the  disease  in  the  lower  animals.  (It  had  failed  in  the 
convict  Keanu  up  to  the  date  of  his  departure.  The  animals 
should  have  been  kept  under  observation  at  least  three  years.) 
He  considers  leprosy  peculiar  to  mankind,  and  transmission 
from  one  person  to  another  directly  through  the  bacilli,  or 
through  the  intermediate  stage  of  spores.  Arning  found  B. 
lep.  in  leprous  corpses,  even  after  the  appearance  of  bacteria 
of  putrefaction;  but  could  not  aver  that  they  were  alive.  B. 
are  not  found  in  the  red  maculae  of  the  face,  which  usher  in 
many  cases.  Excision  from  the  point  of  inoculation  of  Keanu 


Leprosy.  185 

showed  B.  under  microscope  for  fourteen  months,  but  in  dimin- 
ishing numbers.  After  vaccination  of  lepers  he  found  B. 
lepree  in  the  lymph  and  crusts. 

Dr.  Prince  A.  Morrow  (N,  Y.  Med.  Jour.,  July,  '89)  states 
that  he  had  failed  to  find  B.  lep.  in  any  part  of  a  still-born  child 
at  full  term.  (Repeated  observations  would  throw  light  on  the 
heredity  of  leprosy,  and  no  opportunity  should  be  lost.) 

Dr.  J.  H.  Stallard,  of  San  Francisco,  has  kindly  given  me  a 
report  of  his  studies  in  the  bacteriology  of  leprosy,  and  slides 
prepared  by  himself  for  microscopic  observations.  He  finds 
that  the  bacilli  persist  in  water  and  other  fluids;  notwithstand- 
ing the  presence  of  putrefactive  bacteria,  for  at  least  eighteen 
months.  As  they  are  motionless  and  inoculation  is  inadmissi- 
ble we  have  no  positive  evidence  of  activity;  but  the  slides 
show  that  the  bacilli  continue  in  every  possible  form:  as  spores, 
more  or  less  aggregated ;  as  bacilli  of  various  lengths  and  diame- 
ter, plain  or  beaded,  single  or  in  closely  woven  zo-ogloeses. 
His  experiments  indicated  wafer  to  be  the  vehicle  of  contagion. 
After  immersion  of  leprous  tissue  in  absolute  alcohol  for  over  a 
year,  he  found  that  subsequent  treatment  with  water  would  not 
remove  the  bacilli,  though  they  could  still  be  seen  in  situ. 

Dr.  J.  E.  Graham  (Wood's  Eef.  Hand  Book)  remarks:  "  It  is 
probable  that  the  spores  or  bacilli  themselves  find  their  way 
into  the  body  through  some  lesion  in  the  epithelium,  and  thus 
by  their  growth  the  system  is  affected.  Nodules  and  infiltra- 
tions are  thus  the  result  of  specific  irritation -due  to  presence  of 
bacilli." 

The  mechanical  action  of  these  microbes  seems  to  me  a  cor- 
rect supposition.  Their  growth  and  pressure  on  blood  vessels 
and  nerves  satisfactorily  explains  the  mutilations  and  anaesthe- 
sia, and  pressure  on  solid  tissues  accounts  for  the  ulcerations 
characteristic  of  the  disorder. 

The  morphological  resemblance  of  the  bacilli  of  leprosy  to 
those  of  tuberculosis  has  been  observed  by  bacteriologists,  like- 
wise the  slow  growth  of  both  microbes.  The  analogies  in  the 
natural  history  of  the  two  disorders  are  equally  striking;  their 
slow  progress,  their  frequent  arrest  and  occasional  retrogression; 
the  usual  relapse  and  final  determination,  unless  anticipated  by 
a  fatal  intercurrent  attack  of  another  disease;  the  prolonged 
period  of  incubation;  and  probably  in  both  cases  a  necessary 
solution  of  continuity  for  admission  of  the  microbes  to  the 


186  Leprosy. 

internal  organism.     Moreover,  it  may  be  found,  in  time,  that 
heredity  figures  about  as  much  in  one  as  in  the  other. 

The  uniform  presence  of  the  bacilli  in  lepers,  whenever 
looked  for,  and  their  absence  from  non-leprous  subjects,  demon- 
strate their  connection  with  the  disease.  Successful  inoculation 
demonstrates  their  causative  agency  and  its  contagiousness. 
Even  without  the  evidence  of  specific  bacteria,  proofs  of  the 
communicability  of  leprosy  are,  in  my  judgment,  satisfactory: 
with  it  there  is  no  escape.  It  is  improbable  that  these  microbes 
should  find  access  through  sound  mucous  surfaces  of  the  respi- 
ratory or  alimentary  tract,  for  then  the  disease  would  be 
infectious,  like  measles  and  typhoid  fever,  and  vastly  more 
prevalent.  It  is  apparent,  however,  that  individuals  affected 
with  lesions  of  any  tract,  whether  external  or  internal,  accessible 
to  the  air  or  to  food  and  drink,  might  offer  an  avenue  to  leprous 
matter,  either  in  the  moist  or  pulverulent  state.  The  morbid 
intestinal  discharges  and  external  ulcerations  of  lepers  are 
known  to  abound  in  the  specific  bacilli,  and  are  doubtless  the 
general  sources  of  contagion.  Who  knows  the  antecedents  of 
old  rags,  of  the  cast-off  clothing  that  goes  to  the  shoddy  factory, 
of  the  second  hand  clothing  which  many  people  handle  and 
wear?  The  persistency  of  leprous  bacilli  has  been  demon- 
strated. Such  considerations  give  a  creditable  explanation  of 
some  mysterious  cases  and  a  warning  of  danger  lurking  at  unex- 
pected moments. 

THE    CONTROL    OF    LEPROSY. 

This  subject  naturally  falls  under  two  heads:  a,  curative;  b, 
preventive. 

a.  It  is  not  my  intention  to  make  even  the  most  superficial 
review  of  the  various  remedies  and  modes  of  treatment  in  this 
malady,  but  only  to  notice  a  few  agents  lately  approved.  Dr. 
Arning  found  that  the  use  of  ointments  having  ten  per  cent 
strength  of  salicylic  and  pyrogallic  acids  destroyed  the  tubercles, 
softened  the  infiltrations  and  sometimes  restored  sensibility  to 
anaesthetic  patches.  Salicylic  acid  was  tried  also  internally 
with  apparent  benefit.  Hypodermic  injections  of  corrosive 
sublimate,  160  in  the  course  of  two  years,  were  followed  by 
amendment  in  one  case;  in  another,  eighty  injections  were  fol- 
lowed by  retarded  rate  of  progress.  He  found  electricity  bene- 
ficial to  the  anaesthesia.  Potassium  iodide  failed  of  good 
results.  With  apparent  improvement  from  certain  agents,  as 


Leprosy.  187 

above,  he  does  not  claim  lasting  cures.  Dr.  C.  J.  Peters  of 
Bombay  has  used  the  following  course.  1 :  Carbolic  oil  (1  in 
40)  is  rubbed  over  the  whole  body  to  promote  healthy  action  of 
the  skin.  This  is  followed  by  soap  aud  water  ablution.  2:  To 
the  ulcerated  spots  an  emulsion  of  gurgin  oil  and  lime  water  (1 
in  3)  is  applied  by  friction  or  on  cotton  with  a  bandage.  3:  To 
the  anaesthetic  patches  and  tubercular  growths  cashewnut  oil  is 
applied  with  a  brush  or  feather.  4:  Internally  five  minim  doses 
of  Chaulmoogra  with  five  grains  of  sodium  bicarbonate  in 
one  ounce  of  peppermint  water  are  given.  In  some  cases  three 
grain  doses  of  potassium  iodide.  The  results  obtained  were 
healing  of  ulcers,  dispersion  of  tubercles,  restoration  of  sensi- 
bility and  relaxation  of  contractions. 

The  general  testimony,  however,  is  to  the  effect  that  any  mode 
of  treatment  is  in  the  end  disappointing.  Arrest  of  progress  is 
only  temporary,  being  usually  followed  by  suspension  of  treat- 
ment. Indeed  it  is  not  certain  that  long  perseverance  would  be 
attended  by  permanent  relief.  At  the  Tracadie  Hospital 
patients  have  been  discharged  apparently  cured,  but  they  gen- 
erally returned  to  die.  The  results  are  even  less  encouraging 
than  in  the  treatment  of  pulmonary  consumption.  Doubtless 
some  have  improved  enough  to  be  discharged,  have  gone  out 
and  died  of  other  diseases,  and  have  been  considered  cured  of 
their  leprosy;  but  there  is  no  proof ,  and  it  is  rather  probable 
that  in  time  it  would  have  returned.  The  health  authorities  of 
the  Hawaiian  Islands  consider  leprosy  practically  incurable, 
though  they  acknowledge  that  life  may  be  prolonged  by  certain 
medical  treatment,  by  good  food  and  favorable  sanitary  condi- 
tions. 

6.  Since,  then,  so  little  is  to  be  expected  of  curative  treatment 
there  is  no  question  of  the  necessity  of  vigorous  preventive 
measures.  In  the  earliest  stages  recognition  of  the  disease  is 
difficult  and  generally  impracticable,  but  then  the  danger  is 
small.  As  soon  as  diagnosis  can  be  reached  without  risk  of 
making  a  mistake,  there  should  be  no  hesitation  or  failure  about 
enforcing  segregation.  Long  ago  the  people  of  California  rec- 
ognized the  danger  of  planting  leprosy  on  this  coast  through 
Chinese  immigration,  and  for  more  than  fifteen  years  legislation 
has  given  abundant  authority  for  its  exclusion  and  repression. 

Inasmuch  as  the  control  of  leprosy  within  the  national  borders 
belongs  to  the  separate  States,  it  is  highly  desirable  that  they 


188  Leprosy. 

should  enact  substantially  uniform  laws.  The  subject  is  a 
suitable  one  for  the  consideration  and  action  of  the  Conference 
of  State  Boards  of  Health,  and  this  body  could  frame  a  bill 
suitable  as  a  model  for  all  the  states.  It  would  then  be  the 
duty  of  each  State  Board  of  Health  to  procure  the  passage  of  an 
act  for  that  purpose. 

This  part  of  the  subject  would  be  incomplete  without  noting 
some  necessary  precautions  in  disposing  of  leprous  corpses. 
Bacteriologists  have  shown  that  the  bacilli  of  leprosy,  unlike 
many  others,  withstand  the  bacteria  of  putrefaction.  We  know 
that  the  soil  is  poisoned  for  many  years  by  the  bacilli  of  anthrax, 
for  the  rapid  contagiousness  of  the  disease  has  proved  it.  The 
contagion  of  leprosy  is  so  slow  that  proof  may  never  be  made  satis- 
factory how  long  the  virus  persists;  but  danger  is  to  be  appre- 
hended and  it  is  easy  to  obviate  it.  The  law  should  direct  some 
effective  method  or  methods  of  disinfection.  Cremation  would 
certainly  be  effectual,  but  could  not  be  made  compulsory  in  the 
nineteenth  century.  Whoever  lives  to  the  second  half  of  the 
twentieth  century  will  probably  witness  the  cremation  of  bodies 
dead  of  dangerous  disease.  For  the  present  we  might  be  con- 
tent with  burial  in  quicklime,  and  might,  perhaps,  obtain  legal 
authority  to  enforce  it. 

The  full  extent  of  this  fearful  malady  no  one  knows.  Few 
writers  name  even  half  the  countries  where  it  may  be  found. 
Though  the  civilized  world  has  substantially  won  the  victory, 
the  enemy  returns  casually  and  carries  off  one  or  more  victims 
from  the  best  regulated  communities.  In  all  the  four  quarters 
of  the  globe  it  retains  a  foot-hold.  In  its  ancient  seats  of  Asia 
and  Africa  it  holds  undisputed  sway,  almost  without  exception 
stationary,  or  perhaps  slowly  declining,  because  the  races  are 
growing  resistant  by  survival  of  the  fittest.  In  Europe  it  has  a 
strong-hold  in  Norway,  from  which  it  may  be  dislodged  and, 
perhaps,  quite  expelled  within  half  a  century.  It  holds  ill- 
defined  territory  in  Southern  and  Central  America,  the  West 
Indies  and  Mexico,  and  a  small  tract  in  British  America.  In 
Australia  it  is  occupying  new  territory.*  In  the  Sandwich 
Islands  there  is  a  struggle  for  life  between  the  newly  civilized 
people  and  the  destroyer.  In  our  own  country  the  portions 


*The  President  of  the  Board  of  Health  for  New  South  Wales,  "reports  at 
present  twelve  cases  in  Sydney;  ten  Chinamen,  one  Japanese  and  one  English- 
man. Thus  it  is  clearly,  as  in  so  many  other  places,  almost  exclusively  a 
disease  of  Chinamen." — British  Medical  Journal,  February,  1890. 


Leprosy.  189 

once  dominated  by  the  Spaniards,  have  had  the  earliest  and 
latest  experience,  even  to  the  present  hour.  South  Carolina 
has  not  escaped,  Wisconsin,  Iowa  and  Minnesota  have  received 
it  with  Norwegian  settlers,  Utah  with  Mormon  converts,  and  the 
Pacific  States  with  Chinese.  New  York  City  is  seldom  without 
specimens  brought  in  ships  from  queer  ports  in  foreign  lands, 
and  the  other  commercial  cities  are  frequently  startled  with 
strange  visitors.  Occasionally,  as  at  Charleston  in  the  past  and 
New  Orleans  in  the  present,  alarming  numbers  come  to  light. 

Just  now  the  point  most  threatened  is  New  Orleans,  for  no 
legal  barrier  stands  to  protect  the  great  city,  which,  after  a  long 
and  dreadful  struggle,  has  lately  gained  the  mastery  of  tropical 
yellow  fever  by  quarantine.  The  successful  method  of  Ulloa 
and  Miro  is  forgotten  or  unheeded  by  the  authorities,  and  must 
be  rediscovered  to  save  the  people  from  the  fate  of  the  Hawai- 
ians.  Here  in  California  the  enemy,  few  and  scattered,  are  in 
our  midst,  and  others  are  liable  to  come  on  every  ship  from 
China  and  the  Islands;  but  we  have  been  fully  warned,  and  are 
armed  with  lawful  weapons.  It  is  our  own  fault  if  they  do  not 
protect  us. 

One  other  provision  is  needed — a  State  hospital  for  lepers. 
Our  statute  enables  local  authorities  to  act  for  themselves,  but 
not  one  of  the  counties  has  a  suitable  lazaretto.  San  Francisco 
has  always  had  more  than  half  the  lepers  in  the  State,  but  its 
only  accommodation  is  the  pest  house,  where  lepers  and  small- 
pox cases  are  lodged  in  the  same  house.  That  the  lepers  escape 
small-pox  and  the  small-pox  patients  escape  leprosy  is  rather 
good  luck  than  good  management.  At  least  one  leper  has  died 
of  small-pox,  and  some  lepers  of  the  future  may  be  reminded  of 
a  former  residence  at  the  same  institution  for  the  other  com- 
plaint. Apart  from  such  improper  association  of  subjects  of  the 
two  diseases,  the  pest-house  is  an  insecure  place.  Only  lately  a 
leper,  in  a  far  advanced  stage,  has  been  recommitted,  who 
escaped  two  and  one-half  years  ago,  and  was  at  large  in  the  city 
during  the  whole  interval.  A  small  island  near  San  Francisco 
would  be  the  proper  site  for  a  lazaretto,  and  accommodations 
for  twenty-five  lepers  would  be  large  enough  for  present  and 
prospective  needs,  inasmuch  as  most  have  hitherto  been  sent 
back  to  China. 

It  has  also  been  suggested  that  a  contract  be  made  if  possible 
with  the  Hawaiian  Government  to  have  all  lepers  cared  for  at 


190  Leprosy. 

the  leper  settlement  on  Molokai.  In  Louisiana  there  is  impera- 
tive need  of  such  an  institution,  and  of  legislation  equivalent  to 
the  act  of  California.  As  to  the  other  States  ib  would  be  suf- 
ficient to  pass  the  necessary  isolation  act  and  leave  its  execution 
to  the  State  Board  of  Health,  with  power  to  draw  warrants  upon 
the  treasury,  not  to  exceed  a  fixed  amount,  for  the  expenses.  I 
would  not  be  understood  as  encouraging  any  alarm  on  this 
subject,  even  in  Louisiana  or  California.  Our  State  needs  only 
faithful  enforcement  of  existing  laws  with  a  suitable  lazaret; 
while  Louisiana  would  be  saved  by  a  revival  of  the  forgotten 
plan  of  Moro,  which  was  successfully  in  operation  just  a  century 
ago. 

In  conclusion,  I  would  not  be  unmindful  of  courtesies  and 
assistance  rendered  in  the  collection  of  data  for  this  paper  from 
a  large  number  of  correspondents  at  home  and  abroad.  They 
are  too  numerous  for  individual  mention,  further  than  is  already 
indicated.  Among  them  officers  of  Health  Boards  have  rendered 
especial  service.  To  all  I  tender  sincere  thanks. 


MAY  1  6  1979 


R Tom  which  it  wasborrowed. 


3  1970  00475  rv  I" 


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